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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.
Save on select tools to help young learners recognize emotions!
This piece originally appeared at Autism Speaks as part of their Got Questions? series.
My almost 3-year-old was recently diagnosed as having autism spectrum disorder. We struggle going places such as open gym or even the library because he doesn’t like other kids in his space. He does okay with adults, but other kids make him extremely anxious. How do I help him become more comfortable when other children are playing in the same area or with the same set of toys?
I commend you for seeking support for your son at this young age. Receiving a diagnosis of autism spectrum disorder can be challenging and confusing. Yet research shows that early intervention can help maximize cognitive, language and social development.
In my pre-doctoral work at UCLA and my post-doctoral training at Pediatric Minds Early Childhood Treatment Center, my colleagues and I have seen many forms of anxiety in children and teens who have autism. Like your son, many of them experience anxiety around other children, especially groups of children. Understanding the reasons for this anxiety can help select approaches that help.
For example, you mention that your son “does okay” with adults, but not other kids. This is very common. While adults tend to be more consistently friendly and accommodating, children can be very unpredictable. For instance, it’s not unusual for three-year-olds to grab toys from each other, cry, get very close to each other and just be loud! This can be particularly anxiety provoking for someone with autism.
In addition, many people with autism are hypersensitive to sensory input. As a result, public places such as open gyms or even a lively children’s library can be over-stimulating. The sights, sounds and smells can feel intense, uncomfortable and overwhelming. Understandably, this can lead a child to avoid these environments and become upset in the midst of them.
I strongly encourage you to work with your son’s therapists to develop a personalized intervention plan. Children with autism who are under age 3 can qualify for such services through their state’s Early Intervention program. After age 3, these services can be accessed as part of an Individualized Education Plan (IEP) through your school district.
Also see “Access autism services,” for more information on early intervention and individualized education services.
Fortunately, many programs are available to help young children with the type of social anxiety you describe. These include play-based forms of Applied Behavioral Analysis, occupational therapy that includes sensory integration, communication-focused intervention, social skills play groups and other options. Many children do best with a multidisciplinary approach that combines two or more of these methods with close collaboration among the care providers.
Also see, “Autism therapies and supports,” in the “What is autism?” section of this website. While every child has different needs, here are some strategies you can try – ideally in collaboration with your son’s therapists.
Practice. Are there specific social situations that tend to trigger your son’s anxiety? For instance, does he get upset when another child tries to take his hand or pull him into a game? Consider teaching him simple phrases he can use in these situations. For example, a simple “no.” You can also teach and practice toy sharing and turn taking at home. If your child enjoys play dough, for example, place just a few pieces on the table and take turns modeling each of the pieces, handing them back and forth. This can help him learn sharing and even waiting for gradually increasingly periods before getting what he wants. These skills can be difficult to learn. So start with brief periods of waiting and offer plenty of praise along the way. Providing this type of structured opportunities to practice social skills can encourage your son to use them in social settings.
Start slow. A room full of children may be too overwhelming for your child to use the new skills that he’s practiced with you at home. Consider hosting a playdate with one other child who is relatively calm and engaging. Sometimes, a slightly older child will understand how to be more accommodating.
In selecting where to have the playdate, consider your son’s comfort level. You might start at home or maybe a relatively quiet place at a nearby park.
Choose some relatively structured activities such as games or sharable toys that your child knows and likes. Keep the playdates relatively short to further the chances of success.
Bring the familiar. When entering a loud or anxiety producing environment, a comfort object may help provide a sense of security in an otherwise overwhelming environment. Consider allowing your son to bring a familiar toy, stuffed animal or book. Another possibility is a toy or game that actively engages his attention – and so directs his attention away from the hubbub around him.
Be patient. I encourage parents to appreciate that their child’s stage of development may not match what’s typical for his or her age. This is particularly true of social development in children on the autism spectrum. By focusing on small steps, you can foster your child’s confidence and decrease the likelihood of setbacks.
Remember, your child – like all children – is continually developing. You can support his social development – while decreasing anxiety around other children – by providing ample opportunities for success.
About The Author
Dr. John Danial is a 2012 Autism Speaks Weatherstone predoctoral fellow. Dr. Danial’s fellowship supported his work with mentor Jeffrey Wood at the University of California, Los Angeles, developing and evaluating behavioral interventions that reduce anxiety in children, teens and adults with autism and low verbal skills. He is currently completing his post-doctoral placement at Pediatric Minds Early Childhood Center, working with families of children with developmental delays and social-emotional challenges.
This week’s post originally appeared on INCLUDEnyc,
As a mom of a three-year-old with autism, sometimes I’m hesitant to visit places that are overcrowded with people. I always worry that my son Julian will become overwhelmed and have a meltdown. Recently, his daycare took him on a trip to Sesame Place, and despite my worries, I decided to attend. I also invited a friend who has a five-year-old son with autism named Brandon (who is one of Julian’s BFFs).
I created a social story for Julian and told him about all of the characters he would see when we went there. I let him know that we would be playing in the water, going to see Elmo, and that we were going to go on fast rides that went up and down. I spoke to him about Brandon coming with us and how we would be taking a bus. He was very excited and told me he was very happy; or, in his words, “Mommy, Juju happy” (he refers to himself in the third person and always calls himself by his nickname).
The morning of the trip it was a little shaky; we took a car to his school (he was not happy about this because Mommy had only mentioned a bus). When we got on the bus, he was upset and overwhelmed with all of the new changes in his routine. I won’t lie — I was feeling a little overwhelmed myself. It took about 15 minutes for him to calm down, but after that he watched the cars as they drove by and ate lots of snacks, watched parts of a movie that was playing, and climbed all over me. In the end, he didn’t scream and cry the whole time, he didn’t get sick, and best of all, we made it in one piece.
When we arrived at Sesame Place we went straight to the Welcome Center, which was right by the entry gates and, oddly enough, not packed. I told the woman at the desk that we were traveling with two amazing little boys with autism. We were asked basic information like our boys’ names, birthdates, heights and addresses and we were each given a plastic wrist band with the numbers 1-3 on it (each number had a tab that ripped off the band) for water rides. This wristband allowed us to enter the rides through “Abby’s Magic Queue” and skip the long lines 3 times (good for 4 people each time). We were also given a small card with the numbers 1-6, which allowed us to ride 6 dry rides (good for 4 people each ride). We also rented a double stroller for less than $20 which allowed us to stroll both boys and carry our bags easily.
First we did the water rides. We went on a raft/slide ride near the entrance about 4 times in a row. Lucky for us they didn’t ask for any of the tabs. Both boys had a hard time waiting their turn but equally loved the ride; the smiles on their faces were priceless. Next we did the lazy river (for this ride they took one of our tabs); we were able to do this one twice as well. There are some parts on the lazy river where you will get splashed or sprayed by water; we just used ourselves as shields to block them (none of the boys like water in their faces). By the time we finished the lazy river, it was time for lunch. We had chicken fingers and French fries (which only came out to about $30 with a souvenir cup and plate).
Next we went on the dry rides and did just about everything in the Elmo’s World section of the park. For the dry rides we went to the exit and handed our cards to the attendant. They crossed off one number from the card and we were allowed to board the ride first. We had lots of fun on the spinning cups and air balloons. Apparently Julian has a thing for rides that go high in the air (me, not so much; I am afraid of heights). We also went to take a picture with Abby and Elmo, and we were super lucky that there was no line at all.
When it was time to leave, we got to watch some of the parade and wave to some of our favorite characters. Julian was very upset that we had to go and started to cry. Brandon was able to help soothe him by taking his hand and telling him that he was going to be ok. Julian slept the whole ride back on the bus after having some snacks and water. At the end of the day, we actually had a great time despite the normal meltdowns and moments of overstimulation. I was so happy that he had gotten to experience Sesame Place just like any other kid would.
I wrote this blog to encourage other moms of children with disabilities to try and worry less about all the things that can go wrong when experiencing new things, and to take the risk and go for it. Inclusion is one of the most amazing things that places like Sesame Place offer, and best of all, there are supports in place to support our kids. Of course there are going to be bumps in the road, but it’s nothing different than the ones we face every day. Go out, try new things, and follow your child’s lead; the worst thing that can happen is a meltdown (we deal with these anyway). But the best thing that can happen is the making of incredible memories.
About The Author
Millicent Franco is the Program Intake Coordinator for INCLUDEnyc. Millie helps coordinate services for Spanish bilingual families through the help line. Prior to joining INCLUDEnyc, she was a Family Support Worker via Healthy Families New York where she provided families with child development information/activities in order to help create a community of informed parents raising secure children. She also brings previous experience as a Case Manager for Turning Point’s transitional housing program. She is the proud mother of an amazing little boy with Autism and wants to help break the stigma associated with having special needs.