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My Child is Three and Does Not Talk Yet, Does This Mean He Has Autism?

No. There are a variety of disorders that are related to limited speech development but any child that is not talking by the age of three should have a developmental assessment immediately. Most children are babbling before they reach their first birthday and use single words to communicate by 18 months. Any child that does not display these behaviors or who has and subsequently loses a communicative or social skill should be screened for an autism spectrum disorder as soon as possible. For more information, please call (203) 341-4501 to schedule a developmental assessments.

Why ‘Autistic’ and ‘Autism’ Are Not Dirty Words

This article is reprinted from the Huffington Post. The writer, Haley Moss, is a 21 year old with high functioning autism who is an author, artist and autism advocate. Please enjoy:

//www.huffingtonpost.com/haley-moss/why-autistic-and-autism-are-not-dirty-words_b_8925496.html?utm_hp_ref=impact&ir=Impact

Health Talk Radio: Learning With Autism

HTRadioFrank

Dr. Frank Scifo welcomes St. Vincent’s Special Needs Service’s Assistant Principal, Karen King, and Manager of Autism Services, Colleen Gorman. Listen and learn about options for school-aged children with autism.

Click link to listen: //blog.stvincents.org/blog/health-talk-radio-learning-with-autism

Autism and Behavior Change

Let’s face it, coping with a child who has a disability can be very difficult; especially when they display challenging behaviors. It becomes even more difficult if your child is non-verbal, minimally verbal, or experiences other communication challenges. Challenging behavior can involve anything from physical aggression and property destruction to pica (putting inedible items in the mouth) and self stimulatory or repetitive behaviors and anything in between. If the behavior has a negative impact on your child or your family, we would classify it as a challenging or interfering behavior. It’s important to keep in mind that while our children with communication deficits exhibit challenging behaviors, these behaviors do have a function, and there could be a number of reasons why they occur. Information processing difficulties, unstructured time, oversensitivity (hyper) or undersensitivity (hypo) of some environmental or internal event, changes in routines, and feeling unwell, tired or hungry are just a few examples of why challenging behaviors may occur.

When thinking about challenging behaviors, it’s helpful to think about human behavior in general. Behavior can be biologically driven (we put on a sweater when we’re cold) or reflexively driven (we close our eyes if a light is too bright). So, behaviors generally occur because they serve an important function or produce a specific outcome. When challenging behaviors occur, we have to keep in mind that it’s a form of communication. The critical part of addressing such behaviors lies in trying to understand the purpose or function of the behavior. Our behavior is shaped by our environment, specifically what happens directly prior to (antecedent conditions) the behavior and directly after (consequent conditions) the behavior.

As a result of these behaviors being “learned” behaviors, we often see dramatic improvements in behavior by changing the situations and environment surrounding the behavior, or as stated above, the events that come before and after the problem behavior occurs. Gathering this information will assist us in starting to understand why the challenging behavior is occurring. This is part of what is called a functional behavior assessment, and there are many ways to go about collecting such information. This is always the first step in determining how to teach replacement skills that are functional for the child experiencing challenges.

For more detailed information on behavior intervention plans, check out this link to a great PowerPoint presentation on BIPs created by Sonja R. de Boer, Ph.D., BCBA and shared by Autism Speaks:

Autism and Toilet Training

“I wish my child would learn how to use the toilet!” This is the dream of every parent, not just those who have a child with autism or other disability. After all, it frees up the need for diapers or pull ups and opens the doors for more social and educational options available to your child. Toilet training a typically developing child is hard enough, but children with autism bring an additional set of obstacles that could make the toilet training process more complicated (and yes, more frustrating).

Is My Child Ready?
Your child will not experience success with toilet training if he or she is physically not ready. Keep in mind that there is no “magic” age for any child, as every child develops differently. Basically, your child has to have the ability to control the muscles that serve to close off the bladder, and those muscles need to be strong and mature enough. In typically developing children, this generally occurs between 18 and 24 months, but even then, there are variations from child to child. The child with autism might be slower in developing these necessary skills. There are also other skills that need to be in place before starting a toilet training program (this holds true for all children). Other variables indicating readiness for toileting include having the ability to sit, dress and undress, and recognizing the internal clues that indicate the need to urinate or have a bowel movement. The general order of mastery in toileting skills is as follows; bowel control during the night, bowel control during the day, bladder control during the day, and lastly, bladder control during the night. Keep in mind your child may continue to wet the bed during the night even after mastering daytime control.

Look for additional signs that your child is “ready” to start a toilet training program. These “signs” will vary from child to child, of course, but may include indicating discomfort when wet or soiled, “zoning out” and pausing in the middle of an activity, pulling at one’s diaper, or hiding behind a piece of furniture or other barrier in the environment. Other children may start to show interest in the toilet or potty chair. An important telltale sign is when your child starts to stay dry for longer and longer periods of time. To determine the frequency of your child’s urination pattern, it is helpful to check your child frequently and record when your child is dry and when your child is wet. If your child can stay dry between 2 and 3 hours, you can start the process.

Once you have taken data for about a week and understand your child’s elimination pattern, create a schedule that involves taking your child to the bathroom at an interval shorter than when your child typically eliminates. Once you experience success with that interval, gradually increase the time between bathroom visits.

Rule out Medical Issues
Prior to beginning a formal toileting program, it is important to ensure that your child does not have any medical conditions that could possibly interfere with toilet training. This should actually be done for all children, regardless of whether they have autism, another disability, or are typically developing. Medical conditions that could interfere with autism will generally be ruled out during your child’s routine physical exams. Children with autism frequently have gastrointestinal (GI) problems that could make it difficult to maintain a regular toileting schedule. Try to address these GI difficulties (bloating, gas, constipation, diarrhea, abdominal pain) prior to embarking on a toilet training program. Continue to check for too much or too little urination throughout the day, stools that are too loose or too hard, or apparent pain while urinating or having a bowel movement. If you see any of these signs, it would be beneficial to contact your child’s pediatrician for a referral to a specialist.

Tips for Toilet Training
1. Relax. Make sure you approach toilet training in a positive and relaxed manner. Your child will be able to tell if you’re stressed out with the process. Be prepared and know that accidents will occur before your child experiences success.

2. REINFORCE!!! Look at your child’s list of reinforcers. Create a hierarchy of the reinforcers and use the best of the best for toilet training, and ONLY for toilet training. Positive reinforcement is your secret weapon, use it frequently and consistently for all pro-toileting behaviors. Initially, it may be that your child is reinforced for just entering the bathroom, then once your child has mastered that step, move on to the next step and reinforce only that step. Continue to heavily reinforce the current step that your child is working on. Previously mastered steps can be occasionally reinforced to ensure that your child maintains those skills while learning new skills.

3. No Punishment. It’s important that your child NOT be punished when an accident occurs. When your child has an accident, simply say “You are wet/soiled” (whatever words you’ve chosen to use), in a neutral tone of voice. Attempt to bring your child to the bathroom and have him or her sit on the toilet. At this time, reinforce your child just for sitting on the toilet, even if they do not urinate or have a bowel movement.

4. Lots of Fluids. Make sure your child is drinking PLENTY of fluids during the toilet training process. This will increase the liklihood of elimiation in the toilet and thus the opportunity to reinforce!

5. Resistance to Change. Many children with autism have difficulty with change. Try introducing the new bathroom routine very gradually. Expose your child to the bathroom in a nonthreatening way. Start with having your child enter the bathroom fully clothed and see if your child will sit on the toilet clothed. Once your child can easily do this, sit your child on the toilet in his or her diaper, then without the diaper, etc. Try not to use a separate potty chair, this may make it difficult to transition to the regular toilet later on. Get a potty seat that fits directly on the large toilet and use a step stool if necessary.

6. Routine. Develop a structured routine that is followed consistently each time your child uses the bathroom. It is important to follow the routine in the exact same manner each time. Repetition is key! This will increase your child’s success and independence in the process. Make sure the routine you develop involves steps that your child already has the ability to complete independently. Also consider switching your child from diapers to training pants (not pull-ups). Pull-ups are very similar to diapers and absorb too much liquid for the child who may not be able to fully understand he or she is wet.

7. Visual Aids. Children with autism are notorious as being strong visual learners. Keep this in mind when toilet training your child. Try to use visual cues rather than verbal cues. Develop a picture schedule illustrating each step of the process. This can be velcroed on the bathroom wall. Have an empty pouch velcroed at the end of the picture sequence for steps the child has completed. Point to the picture (without saying anything), and then assist your child in completing that step. Once the step is complete, teach your child to remove the picture and place it in the pouch at the end of the sequence. Continue with each subsequent step until the sequence is complete. If your child has responded well to the use of social stories in learning other skills, try using a social story illustrating the toileting routine.

8. Sensory Issues. Autism is generally associated with a variety of sensory issues. Children may be over or hypersensitive to a variety of environmental stimuli. Keep in mind the way your child responds to visual stimuli, smells, sounds, etc. It may be necessary to make some changes in your bathroom environment to make it more comfortable for your child. Consider things like the lighting, the air fresheners or perfumes that might be present, and even the flushing of the toilet. Bathrooms are also typically colder or warmer than other areas of the home, so make accommodations to ensure that the climate is comfortable for your child.

9. Teaching Initiation. Once your child is successful going to the bathroom on the toileting schedule you have developed, it will be important to start teaching initiation. The best way to do this is to be standing in front of your child and have a second person standing behind your child at the scheduled time. If your child is verbal and can imitate words, have the second person (behind the child) say the word “bathroom” for your child to repeat. When your child says “bathroom”, you (in front of your child) should acknowledge this and say “Oh! You have to use the bathroom!”, and reinforce this prompted initiation. If your child is nonverbal, have pictures of bathroom velcroed around the house. Use the same procedure (second person behind). In this scenario, the second person will prompt your child to get the bathroom picture and place it in your hand. Why the second person you may ask? It is very difficult to teach initiation when you prompt your child from the front. In essence, you can’t teach initiation of any skill this way, because the very nature of prompting from the front involves you ”going first” and your child “responding” to your prompt. It’s like me standing in front of you and saying “go ahead, start a conversation with me.” See? You can’t because I have already “gone first”.

Patience is a Virtue
The key to success is simple… PATIENCE! Remember that toilet training your child with autism is likely to start a bit later and take a bit longer as it would with a typically developing child. A habit takes at least three weeks to become a habit! Choose a method that seems to fit you and your child and stick with it for at least three weeks (consistently). Be consistent, stick with it, and don’t get discouraged! Your hard work and your child’s hard work will pay off in time, and you’ll be able to forever say “goodbye” to those diapers!

“My Child Won’t Wear a Coat!”

Transitioning to cold-weather clothing (coats, hats, gloves, etc.) is challenging for many children with autism, especially those who tend to experience more severe sensory issues. In addition to the sensory insensitivities to certain textures, colors, and fit of clothing, there is another sensory processing channel children with autism often experience difficulty with, temperature regulation. Many individuals with autism are unable to set their internal thermometer at a comfortable level. Keep in mind that your child might feel hot in cold weather or cold when it is warm.

Here are some helpful strategies that will hopefully make it easier to keep your piece of mind that your child will be safe and can keep your child warm during the cold winter weather.

1) Provide Choices. Have at least two to three options for each article of winter clothing so you can ask your child to pick one of the available choices. Too many choices may overwhelm your child, so try not to offer a vast array of options.

2) Comfort. Try to buy only the softest, most comfortable clothing available. Cut out tags if they bother your child. Have your child go shopping for winter attire with you and let him/her help to choose the clothing if possible.

3) Model Appropriate Behavior. Your child may be more likely to put on a hat, gloves, etc. if he or she sees family members engaging in the same behavior. You may also want to consider playing “dress up” with paper dolls, baby dolls or a favorite teddy bear using weather-appropriate clothing.

4) Use Visuals. Create a visual story board showing different types of weather and appropriate clothing for each season.

5) Make Dressing Fun. Try to make dressing for the weather fun by making a game out of it. For example, see who can get their coat, hat, and gloves on the most quickly. Allow your child to “win” and make sure there is a favorite reinforce when he or she beats you.

6) Incorporate Dressing Into The Daily Routine. Approach the process of putting on coats, etc. as just one step in your child’s daily routine, make sure that the dressing step is followed by something your child enjoys such as going outside, eating a snack, listening to music, etc.

7) Address Sensory Issues. If your child’s hypersensitivities are causing a problem, address this issue with your child’s doctor or your child’s occupational therapist to help address the issue. Sensory brushing and applying lotion prior to dressing may help to desensitize your child’s skin. Talk to your child’s occupational therapist for more information on sensory brushing.

8) Watch Winter-Themed Movies. If your child enjoys movies and DVD’, choose winter-themed movies to create excitement over the change in seasons, pointing out how the characters are appropriately dressed for the weather.

9) Pick your Battles. If your child wants to go outside in cold weather without a coat, gloves and hat, allow them this as long as it’s not harmful to their health, even if it makes you uncomfortable thinking about how cold they will be. Remember, you are not your child and do not experience the world the way he or she does.

10) Be Understanding. Rather than allowing the issue to become a power struggle between you and your child, let him or her know you understand. You could tell your child that you know the coat is not comfortable or that you realize he or she might not think it’s cold outside. This statement may help deflect some of the attitude that goes along with your demand that your child wear his or her coat. Your child may be more likely to accept your rules if he or she feels they are understood and respected.

“Why Does My Child Hand Flap and Rock?”

Self-stimulatory behavior or “stimming” is defined as repetitive movements or vocalizations involving one or more of the individual’s sensory channels. Stimming is very common in individuals with autism and can take many forms; hand flapping, rocking, finger flicking, spinning and lining up objects, the list goes on and on.

We all engage in self-stimulatory behaviors, especially when we are experiencing emotions such as boredom or excitement. Tapping a pencil on a desk, rocking your leg or foot when sitting, twirling your hair, these are all self-stimulatory behaviors, however, these forms of self-stimulatory behaviors are typically acceptable to society. When individuals with autism engage in self-stimulatory behaviors, they often look unusual, and such behaviors can certainly be stigmatizing. Additionally, even though such behaviors may seem harmless, they can be very detrimental in terms of attentional abilities at home, school, and community settings and can greatly interfere with the learning of new skills.

Experts in the field who have studied self-stimulatory behaviors have hypothesized that there are two primary reasons why individuals with autism engage in these unusual repetitive behaviors. The first theory involves hyposensitivity, that is, the individual’s body craves stimulation. Basically, the self-stimulatory behavior serves to arouse one’s nervous system and provides the individual with some form of internal satisfaction. This is thought to be the result of a dysfunctional system in the brain and/or the nervous system. The second theory involves the opposite function, that is, hypersensitivity. In this theory, self-stimulatory behaviors are not engaged in to excite one’s nervous system, but to calm one self. This could be the result of an environment that is over-stimulating and the individual with autism is experiencing sensory overload, therefore engages in self-stimulatory behaviors not to arouse the nervous system, but to block out the over-stimulating environment.

It might seem logical to simply intervene and try to stop the individual from engaging in the self-stimulatory behavior; however, this strategy is not recommended. Since the individual is engaging in these behaviors for a reason, if we attempt to interrupt and stop the behavior, it is possible that another behavior, that could possibly be more stigmatizing or even harmful, could develop.

If a self-stimulatory behavior interferes with the individual’s ability to pay attention to their environment and participate in important activities, there is a basis for concern. Intervention should involve looking at the sensory channel that is being stimulated and replacing the self-stimulatory behavior with another more socially acceptable behavior that will provide the same type of reinforcement.

Here are some common examples of self-stimulatory behaviors as they relate to sensory channels.

Visual: staring at lights, repetitive blinking, moving fingers in front of the eyes, hand-flapping

Auditory: tapping ears, snapping fingers, unusual vocalizations

Tactile: rubbing the skin with one’s hands or with another object, scratching

Vestibular: rocking front to back, rocking side-to-side

Taste: placing body parts or objects in one’s mouth, licking objects

Smell: smelling objects, sniffing people

If self stimulatory behaviors are interfering with your child’s performance, the following tips might prove to be helpful.

  • The first step to reducing a self-stimulatory behavior is to identify what internal or external variable trigger the behavior and determine when and where the behavior is likely to occur. Once the precursor is identified, we can teach the individual an alternative behavior to cope with that situation.
  • Replacement Behaviors. Finding acceptable replacement behaviors that are more socially acceptable will provide your child with an alternative to the self stimulatory behavior and receive the sensory input desired. For example, the individual who likes to jump up and down can have trampoline time. The individual who likes to hand flap can hold a squishy toy, the individual who chews their shirt and licks objects can be provided with a chew tube or the individual who always hums can listen to music.
  • Both alerting and calming activities can provide socially acceptable alternatives to help reduce self-stimulatory behaviors. Alerting and calming activities can support individuals with autism to learn and interact by helping them stay focused, calm and organized.
  • Individuals who engage in sensory-seeking self-stimulation such as spinning, jumping, etc. can be offered a couple of sensory-based items, such as a squishy ball and Theraputty. Present the individual with one of the items each hour and keep track of the number of self stimulatory behaviors that occur in the following 30 minutes. If the self-stimulatory behaviors decrease, incorporate the sensory items into the daily schedule to help decrease self-stimulatory behaviors.
  • Permit the individual to engage in self-stimulation for a pre-specified period of time as part of his or her daily schedule. For example, it may be calming for your child to engage in self-stimulatory behavior for the first 10 minutes after arriving back home from school.
  • Reduce the amount of stress the individual experiences in all environments. Research shows that self-stimulatory behaviors are more likely to occur following circumstances that are stressful. Attempt to determine what situations are stressful for the individual, and structure the environment in a manner that will reduce stress.
  • Consult an Occupational Therapist to help you develop a sensory diet to address the individual’s need for stimulation. Introducing a sensory diet that involves both calming and alerting activities may help reduce self-stimulatory behaviors. This is not a “diet” related to foods you should serve, but rather it involves an activity plan, designed specifically for your individual child, that provides the sensory input your child needs to be focused and organized.

It is important to remember that even after a successful behavior reduction program, many individuals may return to their old self-stimulatory behaviors in demanding conditions. Addressing self-stimulatory behaviors and trying to find appropriate replacements will improve the quality of life for individuals with autism. A reduction in self-stimulatory behaviors will afford individuals with autism greater opportunity to learn new skills without distraction, interact with others without fear of being stigmatized, and in the end, lead more productive and satisfying lives.

More Than Words

One of the primary goals of parents of children with autism is to help your child communicate with others in a meaningful way. Research has shown that when parents interact with their children in ways that serve to encourage and support communication, they can make a significant difference in their child’s social and communication development.

The ability to communicate with others is one of our most essential skills, and it’s also one that many of us take for granted. The ability to communicate allows us to connect with others and create new relationships. We can make our wants known, share our thoughts and let other people know how we feel.

Communication begins long before we learn to talk. In the first few months of life, babies show their interest in communicating by listening to the voices of others and and looking people’s faces when they talk, and then engaging in back-and-forth babbling games with their parents. These exchanges of sounds and smiles between an infant and his caregiver are the baby’s first conversations, even though he or she has never spoken a word.

For children on the Autism Spectrum, communication develops quite differently and more slowly. The sensory challenges associated with Autism often result in more interest in environmental sounds, like the whirring of a fan or vacuum than in the sound of people talking. Individuals with autism often seem distracted or even seem not to hear what others say. First words are often delayed and, when some children do start talking, their first words can be atypical, or unusual (like numbers) or they may simply echo others.

Research has continually shown that with early speech therapy intervention, there is much that can be done to improve the communication skills of children on the autism spectrum. The important people in the life of a child with autism have the power to make all kinds of learning, including communication, much easier for that child.

The More Than Words Program focuses on your natural, day-to-day life with your child. You’ll discover how to take everyday activities like meal time, story time and bath time and use them to help your child improve his communication and social skills. And you’ll have fun together while you’re doing it!

The More Than Words® guidebook and companion DVD has been extremely useful to families of children with autism. The curriculum outlines straightforward strategies that can be used during daily routines and activities to help children with autism interact more meaningfully with others and experience less frustration. The More Than Words program can help your child to better understand language, social skills, and the ability to engage in back-and-forth interactions.

www.hanen.org/SiteAssets/Helpful-Info/Research-Summary/Learning-Language-Research-Summary.aspx

The More Than Words Program was designed specifically for parents of children ages 5 and under on the autism spectrum. Addressing the unique needs of these children, the program provides parents with the tools, strategies and support they need to help their children reach their full communication potential.

Here are some of the valuable things you’ll learn with the More Than Words Program:

  • How your child learns best and what motivates him to communicate
  • Why your child behaves in certain ways, and what you can do to either increase or reduce those behaviors
  • How to use your knowledge about your child to set realistic goals
  • How to make interactions with your child last longer and be more meaningful
  • Tips for using pictures and print to help your child’s understanding
  • Tips on how to talk so that your child understands you
  • Strategies for developing your child’s play skills
  • Ways to help your child make friends

Here’s an example of a strategy you’ll learn in the program.

“R.O.C.K.™ in your Routine”

Repeat what you say and do
Offer opportunities for your child to take a turn
Cue your child to take his turn; and
Keep it fun! Keep it going!

The R.O.C.K.™ strategy can be used during any activity you do with your child to foster longer, more meaningful interactions and improved social skills.

Like all of Hanen’s programs, More Than Words was developed by expert speech-language pathologists and is grounded in extensive research. The program itself is delivered by Hanen Certified Speech-language pathologists who have completed specialized training from The Hanen Centre.

Autism Awareness: Ten things you should know

If you know someone with an autism spectrum disorder such as classic autism or Asperger’s syndrome, this video will help you understand a little bit more about them.

www.youtube.com/watch?v=x5m5vqrFZpc