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Several years ago, I was working with a 6-year-old boy we’ll call Terrence. Terrence was diagnosed with autism. He was a very playful child who was generally good-tempered, enjoyed playing with trains and watching TV, and posed few difficult behavior issues for his parents…until the day there was construction on their walk from the grocery store to their apartment and they decided to take a different route home. What happened next is what most people would call a full-blown meltdown: Terrence dropped to the ground, screaming and crying, and refused to move.
Many of the parents I work with have a similar story when it comes to their child with autism and an unexpected change in the routine. The change varies: the favorite flavor of fruit snacks is out of stock at the store or the babysitter greeted the child at the bus instead of the parent or they grew out of the coat they wore the past two winters… In fact, it can be difficult to anticipate exactly what specific routine may be a trigger for your learner. This is precisely why building variability into the routine can be helpful.
Here are a few things to consider:
First, think about the routines that are the most likely to be interrupted. Make a list of these so you can begin thinking about how to address those issues.
Second, work with your team (whether that means family or practitioners that work with your learner) to select 2-3 routines to focus on first.
Discuss how those routines would most likely be interrupted. For instance, a favorite TV show may be interrupted during election season or you may have a family function when the TV show is aired. In teaching your learner to be flexible with changes in routine, you will contrive changes that are likely to occur to give your learner quality practice.
Plan to vary the routine. Essentially, you are setting up the change in routine, but you will be prepared in advance to help your learner behave appropriately. (You’re much more likely to experience some success in this scenario than you would be if a change in routine occurs unexpectedly and/or last minute.)
Give your learner a vocabulary for what is happening. I teach many of my students the term “flexible.” I might say, “I appreciate how you’re being flexible right now” or “Sometimes when plans change we have to be flexible. This means…”
Reinforce appropriate behaviors related to flexibility! You want to be clear when they’ve made an appropriate, flexible response. In the planning phase, you can discuss what appropriate reinforcers might be for the routines you are targeting.
If you build in variations in routine and teach your learner some strategies for being flexible, you and your learner are much more likely to be successful in navigating unexpected changes.
Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.
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This week’s post comes to us from Stephanny Freeman, PhD and Kristen Hayashida, MEd, BCBA, and Dr. Tanya Paparella, our partners on the Play Idea Cards app. Play Idea Cards is a full curriculum on teaching play – right in the palm of your hand! Check it out on the Apple App Store!
Most adults think of toy play as a natural part of childhood. When my daughter was born, we were showered with plush animals, tea sets, and dress up clothes for her to use in play. But what happens when the child does not find toy play to be natural?
Many children on the autism spectrum use toys non-functionally or repetitively. When I ask parents of children with ASD to tell me about their child’s play they often say “he doesn’t know how to use toys appropriately!” They then tell me about how the child may spin the wheels on the car while staring at the rotating objects. They tell me about the specific scripts the child uses to carry out a routine with their toys and subsequent tantrums if the routine is disrupted. Parents notice how this deficit in play impacts their ability to engage with peers or occupy their free time appropriately.
Symbolic play occurs when the child uses objects or actions to represent other objects or actions. For example, a child using a doll as their baby and rocking the doll to sleep is an act of symbolic play. The doll is not alive, but the child is representing a baby. This skill is a core deficit in children with ASD. This means that they do not “naturally” or “easily” acquire the ability to use toys to represent other things. Development of symbolic play is crucial in early development and is tied to numerous subsequent skills:
Language: symbolic play is highly correlated to language development. This means that the better the child’s ability to play representationally, the better the child’s language skills. There is also emerging evidence to support symbolic play as having a causal relationship to language. [Explanation].
Social Development: as neurotypical children continue their learning about symbolic play and through symbolic play, children with ASD often struggle to relate to their peers and understand their play schemes. Some children with ASD may only engage peers in physical play (instead of symbolic play) or they may end up playing alone using their familiar play scripts.
Perspective-taking: symbolic play allows the child early opportunities to take on the perspective of another being. If a child pretends to be a pirate, they being to talk and think of things a pirate might want/do. This early practice with perspective-taking allows the child to use this skill when interacting with peers and adults.
Meta-cognition and Problem Solving Skills: meta-cognition is the ability to think about one’s own thinking. This is an essential skill when solving problems and planning one’s time. During play kids plan, organize and cognitively process through obstacles and mishaps with their toys.
Emotional Development: through symbolic play, children can practice expressing emotion through the scenes they create. There is also some evidence suggesting that this early practice contributes to emotion understanding and empathy.
Clearly, children need play for growth and development. However, for children with ASD the development of symbolic play may be difficult and, even thought of as WORK!
Given the numerous skills that come out of symbolic play, we urge parents of children with ASD to consider the importance of toy play. Dedicate time and effort to engage your child in symbolic play. It is usually not easy at first! It might have been decades since you picked up an action figure and used him to fight off bad guys, but practice with your child.
Parents know that it is part of their job to help their child learn to read and do basic math. They would not let their child escape those tasks because they are hard. Please consider PLAY to be just as important and necessary for the child’s development. Even if it is work at first, insist the child play with you and in time, improvements may come not only in toy play but also in so many other key areas of development.
Jarrold, C., Boucher, J., & Smith, P. (1993). Symbolic play in autism: A review. Journal of
Autism and Developmental Disorders, 23(2), 281-307.
Ungerer, J.A. & Sigman, M. (1981). Symbolic play and language comprehension in autistic
children. Journal of the American Academy of Child Psychiatry, 20, 318-337.
About The Authors
Dr. Stephanny Freeman is a clinical professor at UCLA, a licensed clinical psychologist, and Co-Directs the Early Childhood Partial Hospitalization Program (ECPHP). For 20 years, she has educated children with ASD and other exceptionalities as a teacher, studied interventions for social emotional development, and designed curriculum and behavior plans in school and clinic settings.
Kristen Hayashida is a Board Certified Behavior Analyst at the UCLA Early Childhood Partial Hospitalization Program (ECPHP). For the last 10 years she has served as a therapist, researcher and educator of children and families living with autism spectrum disorder through the treatment of problem behavior.
Dr. Tanya Paparella is a specialist in the field of autism having spent more than 20 years in intervention and research in autism. She is an Associate Clinical Professor in the Division of Child Psychiatry at UCLA, a licensed clinical psychologist, and Co-Director of UCLA’s Early Childhood Partial Hospitalization Program (ECPHP), an internationally recognized model treatment program for young children on the autism spectrum.
In the next few weeks I will be writing about ethics in the field of applied behavior analysis. This is the first part in a multi-part series.
Sometimes behavior analysts get a bad rap because we are so focused on the data. Somehow, there is a perception that writing down the numbers and graphing the information is “cold” or “unfeeling” towards the client. Over the course of my career, I’ve had more than one person say to me that I was more fun or more playful than they expected me to be as a behavior analyst. I’m not exactly sure where these misperceptions started, but today I want to get to the root of them.
As a BCBA, I am bound by the Professional and Ethical Compliance Code for Behavior Analysts. Within this code, it clearly states “Clients have a right to effective treatment.” This is something I take to heart every day in my work. And it’s the primary reason that I have my clipboard and am taking data. I want to ensure that the treatment I am introducing is actually effective. My data is what shows me when something is clearly not working, and allows me to be efficient with making changes the best benefit my client.
Clear, objective data allows me to be responsive to data and provide information in a responsible manner. Here are a few things to consider:
• When I graph data daily and look at that information, it’s very easy for me to see if a client’s performance has plateaued, is improving, or is actually getting worse. I can make adjustments based on the trend in the data.
• When all practitioners working with the client graph daily, I might (as the supervisor) see that the client is not performing as well with one practitioner. This might indicate that more training needs to occur. Or, I might see that one practitioner is getting far better results than the others. This might indicate that the practitioner is not recording data correctly or is doing something as part of the intervention that everyone should be doing.
• Data should be collected daily and the teaching programs should be clearly outlined. This way, if for some reason a practitioner abruptly stops working with the client or if the client moves, it is much easier for future practitioners to pick up where the last ones left off.
• Looking at data daily gives an idea of the individual client’s general trends in mastering new skills. For instance, last year I had a client who generally mastered new skills within one week, and his trend in the data was very consistent across all types of skills. So if we introduced a new program and he wasn’t mastering it for three weeks, it was an indication that we needed to re-evaluate what we were teaching or how we were teaching it. Being well-versed in your individual client’s learning patterns allows you to more clearly make individualized decisions!
We’d love to hear from you. What outcomes have you discovered in the relationship between being responsive to data and providing effective treatment for your clients?
Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges.
This week’s blog comes to us from clinical psychologist Lauren Elder and was originally posted on Autism Speaks as part of their Got Questions? series.
“Our son, age 9, was recently diagnosed with autism. He knows something’s up, but we’re not sure how to explain. Advice?”
Yours is a difficult situation shared by many parents. Children need to understand what’s going on, but the discussion needs to be appropriate for their age and level of development. Your openness will help your child feel comfortable coming to you with questions.
I recommend a series of ongoing conversations rather than a one-time discussion. Here are some tips for starting the conversation and preparing some answers for questions that your son may ask:
Explain autism in terms of your child’s strengths and weaknesses
You may want to focus on what he’s good at, and then discuss what’s difficult for him. You can explain that his diagnostic evaluation provided important information on how to use his strengths to meet his challenges. Focus on how everyone has strengths as well as weaknesses. Give some examples for yourself, his siblings and other people he knows.
Provide basic information about autism
Depending on your son’s maturity and understanding, you may want to continue by talking about what autism means. (See our “What Is Autism?” webpage.) You want to give your child a positive but realistic picture.
It may help your son to hear that autism is common and that there are many children like him. This can open a discussion about the strengths and challenges that many children with autism share. You might likewise discuss how individuals with autism tend to differ from other children.
For instance, you might explain that many children with autism are very good at remembering things. Some excel at building things or at math. Also explain that many children with autism have difficulty making friends and communicating with other people.
Don’t make everything about autism
It’s important to emphasize that your son’s autism-related strengths and challenges are just part of who he is and why you love him. Be sure to point out some of those special qualities that have nothing to do with his autism. This will help your child understand that autism is something that he has, not the sum total of who he is.
Assure your child of support
Explain to your son why he’s receiving the services he’s getting. For instance, you could tell him that he sees a speech therapist to help him communicate more clearly, or that he’s seeing a behavioral therapist to improve how he makes friends. Help him understand how you, his therapists and his teachers all want to help him. You can point out that we all need some help to become the best we can be. Some children need extra help learning to read. Some get very sad and need help in that department, etc.
Expect to repeat these conversations!
All children – and especially those with autism – need to hear some information multiple times. This doesn’t mean he doesn’t understand. what you’ve told him. Rather, revisiting these topics can be an important part of his processing the information.
Find role models and peers
It’s important for children with autism to spend time with typically developing peers. However, for children your son’s age and older, it can be a wonderful experience to spend time with other children on the autism spectrum. Consider enrolling your son in a play group or social skills group specifically for children with autism.
This month’s ASAT feature comes to us from Peggy Halliday, MEd, BCBA and David Celiberti, PhD, BCBA-D. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook!
I am concerned that my two year old grandson may have signs of autism, but I am uncomfortable bringing this up with my son and daughter-in-law. Do you have any suggestions about how best to approach them?
It is natural to be unsure of how to share your concerns with your grandson’s parents. As is the case with many concerned family members, you may worry that such a discussion will not be well received or may cause some discomfort or tension in your relationship. If autism is a possibility, you would not want to delay screening and referral for possible evaluation and services because this may waste valuable time during which intervention can be most beneficial for your grandson. Even knowing that the best outcomes are associated with early diagnosis and intensive intervention, it still may be difficult to talk to your son and daughter-in-law if they have not expressed their concerns to you.
As a grandparent, you have already raised at least one child, so you probably have a good sense of what is typical in child development, and what is not. You may feel that your grandson is not making expected gains or may appear delayed in some areas such as communication or play relative to other children his age. Also, you may not have day to day contact so slower development of skills may be more apparent to you. This may create a sense of urgency in you that should be balanced with the need to support your son and daughter-in-law.
There are several important considerations. The way in which you approach your son and daughter-in-law will depend in large part on the quality of your pre-existing relationship and on the nature of how you communicate with one another. You may possess a relationship where difficult issues are frequently and easily discussed. On the other hand, this may not typify the type of relationship that you have. Regardless of your relationship, it is important that you bring this up from a place of love and concern, rather than judgment and blame. Many parents who have been carefully and respectfully approached by a relative later admit that they already had concerns of their own, and it was a relief to discuss them with someone else close to the child.
We would like to offer some concrete suggestions that may increase the likelihood that your discussion will be positive and constructive.
Planning Ahead:
Having the Conversation:
Other Considerations:
The following websites include milestones checklists, booklets, and charts, and a wealth of other helpful information.
About The Authors
Peggy Halliday, MEd, BCBA, is a Board Member of ASAT, and serves as the JCH Director of School Consultation at the Virginia Institute of Autism (VIA) in Charlottesville, Virginia, where she has been a practitioner since 1998. Peggy oversees trainings for parents and professionals and provides consultation to public school divisions throughout Virginia. She also oversees BCBA and BCaBA training experiences. In addition to serving as a presenter at state and national conferences, including the Organization for Autism Research (OAR), Commonwealth Autism Service (CAS), and Association for Behavior Analysis International (ABAI) Peggy was selected as an autism expert for the “how-to” website monkeysee.com. Peggy has been on the board of ASAT since 2010 and serves on the Public Relations Committee.
David Celiberti, PhD, BCBA-D, is the part time Executive Director of ASAT and Past-President, a role he served from 2006 and 2012. He is the Co-Editor of ASAT’s newsletter, Science in Autism Treatment. He received his PhD in clinical psychology from Rutgers University in 1993. Dr. Celiberti has served on a number of advisory boards and special interest groups in the field of autism, applied behavior analysis, and early childhood education, and been an active participant in local fundraising initiatives to support after school programming for economically disadvantaged children. He works in private practice and provides consultation to public and private schools and agencies in underserved areas. He has authored several articles in professional journals and presents frequently at regional, national, and international conferences. In prior positions, Dr. Celiberti taught courses related to applied behavior analysis (ABA) at both the undergraduate and graduate levels, supervised individuals pursuing BCBA certifications, and conducted research in the areas of ABA, family intervention, and autism.