Category Archives: autistic spectrum disorder

Reactions to the Proposed Changes in the DSM-V

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There have been a lot of strong reactions to the proposed changes to the criteria for an Autism diagnosis in the revised DSM-V. We wanted to present some thoughts from some of the people we rely on most:

From Julie Azuma:

We’ve all known for some time that the DSM V is going to exclude some children on the spectrum as in the Asperger’s Syndrome student. Everyone has been asking what we think about it.  The article in last week’s NY Times, alarmed many of our families.

 When Different Roads started participating in the autism community back in 1995, Asperger’s Syndrome was little known.  Somewhere around the year 2002, there was an answer to so many parents who questioned the behaviors of their kids.  Michael John Corley, an advocate of adults with Asperger’s Syndrome said in the NY Times last week, and I paraphrase…”some people needed to give it a name and to understand. ”

For those parents of children who are more classically affected by autism, they will continue to get services; those without language, academic or daily living skills.  And we want them to continue to get support.

Even if Asperger’s Syndrome or PDD NOS in no longer in the DSM V, we think that the cat is out of the bag.   Awareness has already set in.  Parents will continue to advocate and fight for services, classes and programs for their children. One way or another, this will not be a setback but a new road of discovery on ways to support all of our kids.

We know our parents, and we know that they won’t give up getting whatever their children need.

 From Justin DiScalfani, Clinical Director of The Elija School

The proposed changes to the DSM-V for the Autism Spectrum Disorders would have a profound impact on those dealing with this disability. These changes would greatly reduce the rates of people diagnosed with autism. The primary question is: What will happen to those that would have received a diagnosis under the old criteria but no longer receive the diagnosis under the new criteria? The biggest concern with combining the different diagnoses from the current DSM-IV (Asperger’s, Autism, PDD ) into one category with only three different levels is that it may exclude thousands of children and adults from obtaining crucial services that are necessary for them to become functioning members of society. Policy makers and school districts will be able to use this change as an opportunity to restrict services to those in need. They may also use the proposed level system of severity to allocate more services to the more severely impaired individuals while more mildly impaired individuals may not be given adequate services. Another extremely important area of concern surrounding this change is that it may restrict insurance coverage for people with Autism that many families and advocates have worked so long and hard to reform and recently pass across the country.

Combining the diagnoses of Autism and Asperger’s may also have a negative social impact for these groups. Many children and adults have formed identities for themselves to help cope with their disabilities and to advocate for services for themselves and others around them. People diagnosed with Asperger’s will often refer to themselves as “Aspies”. People with this diagnosis have also formed social groups during which they meet others with the same diagnosis to discuss difficulties that they face and ways in which they are able to integrate into society. By combining all Autism Spectrum Disorders into one category, people such as the “Aspies” could suffer a great loss of personal identity.

Finally, another major issue with the proposed changes concerns the research that has been conducted on the etiology and treatment of these disorders over the past decades. Many studies select subjects based on their diagnosis. With the combining of the diagnoses into one large category, it will be difficult to compare any research that has been conducted in the past to research that will be conducted in the future.


Teaching Interactions – Strategies for Teaching Students with ASD by Autism Partnership

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Teaching Interactions

 Teaching Interactions (TI’s) are another instructional format that can be invaluable in teaching children skills.  This instructional technique was developed at the University of Kansas as part of the Teaching Family Model for delinquent youth.  TI’s have several benefits as it allows for structured training of more complex, often sophisticated skills in a highly natural, interpersonal, expanded conversational format.  TI’s are designed to teach complex skills (e.g., social skills, problem solving, etc.).  They utilize shaping and reinforcement to teach a skill and rely on a task analysis format.  The teaching style is typically conversational and flexible in nature, providing the student multiple opportunities to participate in the teaching process.  Although flexible, the technique approaches teaching skills systematically, and requires planning for generalization.  Following are the 6 steps of a TI and both guidelines and considerations when utilizing this teaching technique.

 

  • Initiation & Labeling
  • Rationale
  • Demonstration
  • Practice
  • Feedback
  • Consequences

This is part of a guest series by Autism Partnership founders Ron Leaf, John McEachin and Mitchell Taubmann. Established in 1994, Autism Partnership is one of the nation’s premier agencies dedicated to providing intensive behavior intervention for children with autism and their families. They offer a comprehensive program and a variety of proven services, including in-home, in-classroom and one-on-one, as well as lectures and workshops. All programs are handled by expert staff and tailored to each individual child, family and caregiver, with the goal of helping that child achieve their best life. For more information, visit www.autismpartnership.com.

Pick of the Week: NEW! Language Builder Picture Nouns Software

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This week, we’re so excited to introduce you to the new Language Builder Picture Nouns Software. We’re also thrilled to be the first to offer this wonderful program. For the next 2 weeks – to celebrate our worldwide exclusive on this new program – we’re offering you 15% off!

Based on the top-selling flashcards – The Language Builder – this innovative software program transforms basic flashcards into an interactive digital learning experience. The 550 Images are taken directly from the popular Language Builder Picture Nouns 1 & 2. There are 550 images presented through six different activities. The easy-to-use interface gives you the ability to select which words, word lists, or categories you want to practice.

Activities Include: Identification, Matching, Multiple Choice, Sorting Similar Images, Grouping by Category, and a Voice Recorder Function. The Word Groups include: Wild Animals, Farm Animals, Pets, Sea Life, Insects & Bugs, Foods, Clothing, Vehicles, Toys, Musical Instruments, Everyday Objects, Body Parts, Safety Signs, and Shapes & Color.

To redeem your 15% discount and be the first to purchase this great new program, simply purchase the Language Builder Picture Nouns Software and enter the Promo Code BLOGLBPS at checkout.

*Offer expires on February 7, 2012 at 11:59 pm EST. Not compatible with any other offer. Be sure there are no spaces after the Promo Code when you enter it at checkout.

Drive Me to the Sea

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Last month, I was asked to support a viewing of a Japanese film about autism, “Drive Me to the Sea.”   I was so excited that the Japanese community was interested in autism awareness that I threw myself into promoting the film without knowing the details of the story.  I was doubtful that the film would portray autism appropriately (by my standards).  Upon viewing it, it does.  Everyone on the ASD spectrum is different but this film thoughtfully connects all of us affected by autism. The screenwriter, Kuniaki Yamashita, was a parent of a young man on the spectrum and a core advocate of people affected by ASD.

Jun, the young man with ASD, loves everything about cars and driving.  He has very limited language and independence and lives at home with his family.  There are scenes of what life is like for the family; his mother, his brother and their ties to the disability community. A young woman who knows nothing about autism gives a ride to Jun because he reminds her of someone in her past.  Jun loves everything about cars and vans, so of course, he got in the car and the adventure begins.

The film is about autism awareness, education, advocacy but more importantly acceptance; acceptance of behaviors and inclusion into the mainstream community.   The film gives the autistic person a place in our community.

Wouldn’t it be wonderful if we were able to gain acceptance for our children in the global community?  The film was a glimpse of promising possibilities.

Learning How to Learn – Strategies for Teaching Students with ASD by Autism Partnership

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“Learning How to Learn”    

Teachers and parents are often eager to teacher children language, social and academic skills.  Clearly, these are important objectives that are essential for children’s well being.  It is generally recognized, that in order for children to be successful in learning these skills that their disruptive behaviors must not interfere in the learning processes.  Therefore behaviors such as aggression, non-compliance and self stimulation must be targeted prior to teaching more formal skills.  However, there is another critical perquisite skill that is essential in order to maximize learning success.  Acquiring “learning to learn” skills is absolutely pivotal in a child’s success.  It is really teaching children the process of learning.  It is the foundation, perhaps the pivotal skill necessary for them to acquire all other skills. Often when a child is struggling in learning beginning or even advanced skills it is often because the child is deficient in this area.  “Learning to learn skills” include some of the following skills:

    • Attending
    • Returning Reinforcers
    • Hands Still
    • Waiting
    • Responding to Instruction
    • Changing Behavior Based Upon Feedback
    • Learning From Prompts
    • Remaining Calm

 

    “Learning to learn” skills often are not directly targeted.  Typically by the time children participate in more formal instruction they have learned these behaviors.  However, the majority of children with ASD require direct teaching to understand these critical skills.  Therefore, systematic programs designed to teach these critical skills are essential.

This is part of a guest series by Autism Partnership founders Ron Leaf, John McEachin and Mitchell Taubmann. Established in 1994, Autism Partnership is one of the nation’s premier agencies dedicated to providing intensive behavior intervention for children with autism and their families. They offer a comprehensive program and a variety of proven services, including in-home, in-classroom and one-on-one, as well as lectures and workshops. All programs are handled by expert staff and tailored to each individual child, family and caregiver, with the goal of helping that child achieve their best life. For more information, visit www.autismpartnership.com.

Changes to Definition of Autism to Exclude Many Currently Diagnosed on the Spectrum

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A new study by an expert panel appointed by the American Psychiatric Association is examining the impact that the proposed changes to the definition of Autism under the DSM-V would have both on diagnosis and on access to services. The changes would almost certainly exclude high functioning individuals. For more complete details on the findings and the ramifications, read the full article New Definition of Autism Will Exclude Many, Study Suggests in the NY Times.

This obviously raises a lot of strong emotions in our community. How do you feel about the changes? Do you think it would affect the access that your children or students would have to services?

“Cool” versus “Not Cool” – Strategies for Teaching Students with ASD by Autism Partnership

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“Cool” versus “Not Cool”

Children understanding appropriate versus inappropriate behaviors and correct versus incorrect responses are a fundamental aspect of intervention.  When children can recognize these distinctions it can help change their performance.  And when it can be taught in a fun way it can help motivate children them not only to acquire the information but to use it in their everyday life.

This discrimination can be used to teach a variety of concepts.  We have used it to successfully teach children to reduce self-stimulation and acting out behaviors.  Children have also learned pro social behaviors such as personal boundaries, recognizing when they are boring peers and empathy through this strategy.  Voice modulation and even articulation have improved through “cool/not cool”. 

There is nothing magic in the words “cool” or “not cool”!  Use words that are appropriate for age, level of understanding or that are common used among peers.  For example, you could use “good idea” vs. “not such a good idea” or “great” vs. “not so great”.  Instead of words teachers could use thumbs up vs. thumbs down or a smiley face vs. a sad face.

This is part of a guest series by Autism Partnership founders Ron Leaf, John McEachin and Mitchell Taubmann. Established in 1994, Autism Partnership is one of the nation’s premier agencies dedicated to providing intensive behavior intervention for children with autism and their families. They offer a comprehensive program and a variety of proven services, including in-home, in-classroom and one-on-one, as well as lectures and workshops. All programs are handled by expert staff and tailored to each individual child, family and caregiver, with the goal of helping that child achieve their best life. For more information, visit www.autismpartnership.com.

Strategies for Teaching Students with ASD: A Guest Series by Autism Partnership

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We can’t tell you how excited we are to introduce a series of guest posts by Autism Partnership. Really, they don’t need any introduction: Ron Leaf, John McEachin, and Mitchell Taubman have been working in ABA since the 1970’s when they were all  working with Lovaas on the seminal UCLA Young Autism Project. They’ve dedicated their careers to providing services, training and direct intervention to individuals with ASD. It’s a rare to treat to get insight and information from such distinguished professionals.

In this  series, they’ll offer up strategies and tips on Learning How to Learn, “Cool” vs. “Not Cool”, Teaching Interactions, Reinforcement Development, and Individualized Token Economy Systems, as well as results from a recent study that shows promising treatment results in children with ASD. But first, an introduction in their own words:

The three of us met over 35 years ago on the UCLA Young Autism Project.  Our careers have been devoted to helping children, adolescents and adults develop the skills and behaviors so that they can enjoy the highest quality of life.  Although Applied Behavior Analysis remains the foundation of our approach the application has evolved.  This evolution has been due to a number of factors including working with a range of ages (toddlers, children, adolescents and adults) working in a variety of settings (clinics, homes, schools, private practice, residential and vocational settings) and not only working with Autism Spectrum Disorders but a large variety of populations (ADHD, Mental Retardation, Juvenile Delinquency, Prader Willi Syndrome, Schizophrenia as well as adolescents and adults  being challenged by depression, anxiety and marital conflicts).  Our journey has been challenging, exhilarating and humbling.

When we wrote our first book, Work in Progress, we believed it was our last book.  We had believed we would have nothing more to contribute!  However, years later we were frustrated that ABA was not being used to help students in schools so we wrote It’s Time for School.  But the insanity and misinformation regarding ASD and ABA compelled us to write It Has to Be Said!   It provided through grumpy men a chance to enlighten the world according to our belief system!  We weren’t quite done!  Recently, we recognized that lack of emphasis on teaching social skills so we wrote Crafting Connections. 

We have also been passionate of conducting research so as to objectively validate our approach.  We have conducted numerous research studies investigating various techniques and procedures.  Through these efforts hopefully we have contributed to the field.  But we know the research has made us better clinicians.  It has also provided evidence as to the efficacy of ABA.  Recently we published a 10 year outcome study allowing us to evaluate our approach.

In this Blog we would like to share a summary of our most recent programs and findings.  We hope that you will find them interesting and perhaps even helpful.

Cheers,

 John, Mitch & Ron

Toilet Training Tips

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So, I’ve taken to spending the majority of a weekend when necessary, with families when it comes to toilet training their child.  It’s highly glamorous, really.  Just the mom, the dad, the child and me cooped up in the family bathroom for six or more hours at a time.  I brought donuts on the second day just in case anyone was in need of a morale boost since I left the parents on their own at the end of the first day.  They had a fresh pot of coffee on and were still in good spirits.  All kidding aside, it’s really the only way to do it.  During the weekend you are free from the week’s distractions and you have the entire family there for carry over, which in the long run is the deciding factor in a child’s success and generalization.  So, while I’ve been helping families with toilet training for years this was the first time I spent two full days helping to implement the protocol.  I thought I could share with you my general tips from years of experience along with some new insights from my newest adventure in toileting that I like to call the “weekend warrior”.

 First, we will start with the general tips:

 Prepare, prepare, prepare! This means talking about toileting every chance you get.

  • Learn your child’s routine (when do they typically “go”)
  • Watch videos about toileting
  • Read books or social stories about toileting
  • Use a doll for pretend toileting
  • Allow your child to watch you use the toilet
  • Provide opportunities to “try” without any pressure

 Gather materials. You want to have it all before starting.

  • A comfortable potty seat that fits over the toilet
  • A footstool for resting their feet and providing postural support
  • Data sheets
  • A timer
  • Lots of underwear!
  • Highly preferred snacks and drinks
  • As many reinforcers you can identify as highly motivating

 Several days before you begin:

  • Increase fluids to make sure child is well hydrated
  • Eliminate access to all items identified as highly preferred reinforcers to maintain potency

 What did I learn?

  • Adherence to the protocol is important but above all there needs to be a discussion regarding what makes the most sense for the family.  This was more apparent to me than ever having been in the home for so many consecutive hours.  For example, I feel strongly about going straight to underwear from diapers without using an intermediate type of coverage.  However, the stress of cleaning up possible accidents resulted in anxiety on the part of the parents, which in turn led to stress on the child (reducing success).  So, after two days in underwear we went to pull-ups and guess what, the child kept it dry the majority of the time!  This experience should be a collaborative partnership with the family, whatever protocol you are using; if it doesn’t make sense to the parent it won’t work.  It is our job as providers to individualize the plan for each family in a way that empowers them without compromising the core details of the protocol. 
  • I also feel rather strongly about starting on the regular potty instead of a little child potty.  However, we ended up doing a combination of both with great success.  It turns out that the child did better with the postural support provided by the child potty.  Since, he didn’t show any fear surrounding the use of the actual toilet we decided it was ok to use the potty and later transition to the toilet. 

If you think your you and your child are ready these are my “go to” references.  Best of luck!

Azrin, N.H., and Foxx, R.M. Toilet Training in Less Than A Day. New York, NY: Pocket Books, a division of Simon & Schuster, Inc., 1976. 

Kroeger, K. and Sorensen, R. (2010), A parent training model for toilet training children with autism. Journal of Intellectual Disability Research, 54: 556–567. doi: 10.1111/j.1365-2788.2010.01286.x.  (Click the title to download the full article).

 

Unpacking My Suitcase and Reflecting

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I’m just back from a two-week vacation in California where I spent the time with a good friend and her 22-month-old son.  Now, with a couple of days in New York City before returning to work I find myself reflecting on the time spent and the lessons revealed that could inform my work with children with special needs.  Since I have no kids of my own I spend the majority of my time with children in a work capacity with therapeutic intentions in mind.  It was fascinating and refreshing for me to just be present in the moment (as much as possible after 15 years in the field) and enjoy his company and play together.  

This rambunctious little boy reminded me of just how much variability there is from child to child when it comes to development.  He is always busy, on the move, and loves his toy vehicles.  As a child who is being raised bilingually his expressive language isn’t yet robust but he can communicate his wants and needs clearly.  Much of this variability is what we might call personality and I couldn’t help but think that perhaps in our efforts, as professionals, to facilitate development we can easily overshadow the personality and idiosyncratic interests of each child that deserve to be revered and honored.  For example, an interest in trains is sometimes just that, an interest in trains.  Dumping items on a hard wood floor so that you can hear the sound they make when they drop is sometimes what a two year old does when exploring the properties of the items in their environment.  Wanting to pretend to have a birthday party over and over again with fake candles because you just figured out the magic of what it all means is again, what a young child sometimes does in order to gain mastery over their environment and experiences.  Of course, with a typically developing child these things are of no concern as they can be with a child with autism but it reminded me that sometimes we can’t see the forest for the trees and can get lost in the details while losing valuable opportunities to connect and teach.

 I also walked away from my vacation thinking about the fact that many of my clients who are close to the same age as my friend’s child have a definite leg up on him in the academic department (all things explicitly taught by the team of course) but the things that he could do that my clients don’t do were the skills that really resonated with me.  Within a day we developed our own silly little thumbs up signal to each other as a means of connecting and building a friendship, within two days he was calling my name at the top of his voice when I wasn’t where he could find me, and when he looked at me he really looked at me with sparkles in his eyes.  These are the things that are so hard to teach but really are a core deficit of autism spectrum disorder.  I know I strive in my work to foster these skills along with cognitive skills but was reminded on vacation of just how early these skills develop and that maybe just maybe the prepositions or sequencing can sometimes wait a little bit longer.

~Stacy