The Litmus Test for Behavior/Treatment Strategies -- Bill Nason
Autism Discussion Page
This page is developed around a tool box of strategies to help the child feel “safe, accepted, and competent.” After 30 years in the field I have narrowed my analysis down to a foundation that we all have a strong need to feel safe, accepted, and competent. In my job, most people approaching me are seeking help in dealing with a host of social, emotional, and behavioral challenges; almost everyone feeling vulnerable and inadequate in dealing with these challenges. Every individual comes with their own unique strengths and vulnerabilities, social and emotional challenges, and a past history of repeated failure in trying to integrate in society. In addition, all the people supporting the individual (parents, relatives, teachers, etc.) also are frustrated and vulnerable, and feeling incompetent in dealing with the challenges.
In our drastic attempts to “change behavior”, others may want to assign harmful intent to the child, and wish to punish, suspend, or otherwise “force” the child to comply. When we don’t understand the conditions presenting the challenges, we turn to modifying behavior by manipulating consequences. More times than not it either doesn’t help, or makes things worse. It often ends up not reducing the conditions presenting the behavior, but usually ends up invalidating the child. Often we are acting out of frustration when we ourselves are feeling inadequate. Just like the child who needs to “control” when feeling inadequate, us adults will do the same when feeling incompetent.
In my 30 years in the field, I’ve found that if we change the conditions around the child so he feels safe, accepted, and competent, then every child grows and develops. Problematic behavior occurs when we put the child in situations for which the demands of the situation outweigh the child’s current skills for dealing with them. Either the child feels insecure, unaccepted, or incompetent in dealing with the current demands. When the child feels (1) safe and secure (physically, socially, and emotionally), (2) accepted, respected, and valued, and (3) competent in tackling the current demands, then problem behavior subside, and adaptive growth occurs. This is why the current “positive behavior supports” systems are mandated (but rarely used correctly) in our school systems. Positive behavior supports are strategies to lessen the stressors, accommodate for vulnerabilities, match demands to current abilities, and teach better skills for dealing with the social and emotional demands.
So, my request of you is to use this model as a litmus test when evaluating strategies that professionals, teachers, family and friends recommend to use. Ask yourself (and them) “In what way does this strategy help my child feel more safe, accepted, or competent?” If they want your child to loss privileges, force them to stay in situations that are overwhelming them, suspending them from school, or pressure them into compliance, ask them “In what way does this procedure support my child to feel safe, accepted, and competent.” If it doesn’t help support one of those three things, then be very cautious. Most likely the procedure will just invalidate the child even more, and lead him or her to feel even more incompetent than they already feel. If the procedure doesn’t (1) lessen stressors, (2) change demands, (3) accommodate vulnerabilities, or (4) teach better skills, it probably is not a good procedure to use. Whatever strategy that is used, ask yourself how does it support my child to feel “safe, accepted, and competent.” If it does, then you cannot go wrong. Everyone will benefit, feel more competent, and grow more connected with each other. This litmus test is simple, and accurate
Thursday, May 24, 2012
Wednesday, May 23, 2012
Strategies for Learning Hidden Curriculum
Hidden curriculum is a term that refers to all of those social skills that most kids just know about and understand -- the unstated rules or customs that make the world a confusing place for many students with autism spectrum disorders. Madison's very-own Judy Endow -- an international consultant, trainer, writer who has autism and has raised a son with autism -- has recently provided many useful resources that address the topic (e.g., "Hidden Curriculum One-a-day Calendar for Older Adolescents and Adults: Items for Understanding Unstated Rules in Social Situations", "Learning the Hidden Curriculum, The Odyssey of One Autistic Adult"). Most recently, Judy has posted an informative blog on the topic, Strategies for Learning Social Skills and Hidden Curriculum. I think that you will find the post humorous, interesting, and informative.
Get Me Started But Let Me Finish
Here's another interesting post on Bill Nason's Facebook page, Autism Discussion Page
Get me started, but let me finish!
Many children on the spectrum suffer from “self initiation” and “sustained attention” difficulties. These two functions are part of the “executive functioning” skills located in the frontal cortex of the brain. This explains why many kids appear to “lack motivation” and need to be jump started to do everything. The ability to initiate an action, especially if it is task related, is often impaired. For these children, they have difficulty taking the first step to get started. They tend to blank out and freeze. However, once the first step is made then they move forward with the action/task. This is the person that needs to be continually prompted to get up and “doing.” Unfortunately, such children are labeled as “lazy”, “unmotivated”, or worse yet, “incapable.”
Many of these same children also have problems with “sustaining attention”; staying on course until the task is completed. They become distracted very easily, and have difficulty concentrating long enough to follow through with sequential tasks. Again, they are often labeled as “lazy”, “unmotivated”, and worse yet “incapable.” Unfortunately, reinforcing these labels, is the child’s ability to “initiate” and “sustain attention” for the video games, and other special interests. “He can sit in front of video games for hours, so I know he can initiate and sustain attention!” The reason for this paradox is because the preferred interest is highly stimulating; alerting the executive functioning part of the brain, allowing it to focus. The problem comes when tasks are (1) low level of excitement, and (2) not a preferred activity.
Both of the above problems are also augmented by another executive functioning issue call “shifting gears.” This is the ability to leave one activity and transition to another. This is overlaps with the “initiating” function. This is especially evident when it comes to ending a preferred activity (video game) to do a nonpreferred activity (feed the dog). Not only does the child have a hard time starting an activity, but also stopping the activity. So, not only do you have to “nag” them to do something, you may also need to “nag” them to stop.
So, the message is don’t assume “incompetence or laziness” because you child needs to be supported to start doing everything. Stop “nagging” and getting angry. Most importantly don’t assume your child is incapable of “doing” and stop jump starting them. Try the following:
1. Try to build a structured schedule into your child’s day, so many of his routines stay consistent from day to day. This builds structure and predictability for the child. Over time develop picture, or written, schedules and task lists, so the child has a visual reminder of what they are doing, and what is coming up next. Checking off each task, when finished, cues them into what they are to do next. Task lists (or picture routines) can also help cue the child into the steps for each task.
2. To help the child stop one activity and move to the next (shifting gears), prepare the child with a warning. First get used to letting the child know what is coming up next, after completing the current task. “First you can watch T.V., and then it will be shower.” Then with three minutes left to go with the current task, remind the child “In three minutes we will be ending ___ and doing ____.” Then remind again with one minute left. This helps prepare the brain for what is coming up.
3. For children that have “initiation” problems, assist them in starting the first step, to jump start their participation. Try not to give repeated verbal prompts (nagging). If they do not respond on the first try, use a visual (hand them the tooth brush, if brushing is up next.) Provide support as needed.
4. If they have problems with “sustaining attention” you may need to stay nearby and provide occasional prompts to move from one step to another. For new tasks, until they learn the steps, try doing it together, assisting as needed, but expecting them to actively participate. By turning the tasks into “we-do” activities, you can bridge the brain difficulties until the task becomes automatic.
Over time, as the routines become more automatic, you can fade out many of the supports. However, these functions (initiation, sustained attention, and shifting gears) will always be weaknesses. The person will need to use such techniques to learn new routines. However, as they get older they learn to use lists and schedules to keep them organized.
In conclusion, do not lower your expectations, just provide the supports to compensate for the brain weaknesses that interfere with your child’s participation. Always expect active participation, and foster independence. “Help them get started, but let them finish!”
Get me started, but let me finish!
Many children on the spectrum suffer from “self initiation” and “sustained attention” difficulties. These two functions are part of the “executive functioning” skills located in the frontal cortex of the brain. This explains why many kids appear to “lack motivation” and need to be jump started to do everything. The ability to initiate an action, especially if it is task related, is often impaired. For these children, they have difficulty taking the first step to get started. They tend to blank out and freeze. However, once the first step is made then they move forward with the action/task. This is the person that needs to be continually prompted to get up and “doing.” Unfortunately, such children are labeled as “lazy”, “unmotivated”, or worse yet, “incapable.”
Many of these same children also have problems with “sustaining attention”; staying on course until the task is completed. They become distracted very easily, and have difficulty concentrating long enough to follow through with sequential tasks. Again, they are often labeled as “lazy”, “unmotivated”, and worse yet “incapable.” Unfortunately, reinforcing these labels, is the child’s ability to “initiate” and “sustain attention” for the video games, and other special interests. “He can sit in front of video games for hours, so I know he can initiate and sustain attention!” The reason for this paradox is because the preferred interest is highly stimulating; alerting the executive functioning part of the brain, allowing it to focus. The problem comes when tasks are (1) low level of excitement, and (2) not a preferred activity.
Both of the above problems are also augmented by another executive functioning issue call “shifting gears.” This is the ability to leave one activity and transition to another. This is overlaps with the “initiating” function. This is especially evident when it comes to ending a preferred activity (video game) to do a nonpreferred activity (feed the dog). Not only does the child have a hard time starting an activity, but also stopping the activity. So, not only do you have to “nag” them to do something, you may also need to “nag” them to stop.
So, the message is don’t assume “incompetence or laziness” because you child needs to be supported to start doing everything. Stop “nagging” and getting angry. Most importantly don’t assume your child is incapable of “doing” and stop jump starting them. Try the following:
1. Try to build a structured schedule into your child’s day, so many of his routines stay consistent from day to day. This builds structure and predictability for the child. Over time develop picture, or written, schedules and task lists, so the child has a visual reminder of what they are doing, and what is coming up next. Checking off each task, when finished, cues them into what they are to do next. Task lists (or picture routines) can also help cue the child into the steps for each task.
2. To help the child stop one activity and move to the next (shifting gears), prepare the child with a warning. First get used to letting the child know what is coming up next, after completing the current task. “First you can watch T.V., and then it will be shower.” Then with three minutes left to go with the current task, remind the child “In three minutes we will be ending ___ and doing ____.” Then remind again with one minute left. This helps prepare the brain for what is coming up.
3. For children that have “initiation” problems, assist them in starting the first step, to jump start their participation. Try not to give repeated verbal prompts (nagging). If they do not respond on the first try, use a visual (hand them the tooth brush, if brushing is up next.) Provide support as needed.
4. If they have problems with “sustaining attention” you may need to stay nearby and provide occasional prompts to move from one step to another. For new tasks, until they learn the steps, try doing it together, assisting as needed, but expecting them to actively participate. By turning the tasks into “we-do” activities, you can bridge the brain difficulties until the task becomes automatic.
Over time, as the routines become more automatic, you can fade out many of the supports. However, these functions (initiation, sustained attention, and shifting gears) will always be weaknesses. The person will need to use such techniques to learn new routines. However, as they get older they learn to use lists and schedules to keep them organized.
In conclusion, do not lower your expectations, just provide the supports to compensate for the brain weaknesses that interfere with your child’s participation. Always expect active participation, and foster independence. “Help them get started, but let them finish!”
Help Me I'm Stuck
I recently came across a Facebook page entitled, "Autism Discussion Group". This page was developed by Bill Nason, MS LLP to discuss tools that help children on the autism spectrum feel safe, accepted, and competent. Although each child is different, with their unique strengths and challenges, there are some common strategies that can strengthen the social, emotional, and cognitive security for most children on the spectrum. Come learn, share, and support.
I found the page to have some helpful strategies and information that I believe school staff and families will find helpful. If you are on Facebook, I encourage to visit the page and spend some time checking out all of Bill's great ideas. In particular, related to past posts we have made regarding movement issues and accommodations, I offer you Bill's thoughts and ideas regarding what to do when students with whom you support get stuck:
HELP ME I'M STUCK
(Autism Discussion Page)
Does your child get stuck in an action that they seem to have difficulty shifting from? This might be a repetitive behavior, vocal noise, activity, or thought. With this problem, the child will initiate the behavior, task, or thought and seem to have difficulty ending it. They continue on and on in a fixated pattern.
Our ability to shift from one activity or thought to another is an executive function of frontal cortex of our brain. It allows us to initiate, implement, and stop a behavior fluidly with little difficulty. For many children on the spectrum, these functions are weak. Once a behavior gets started, and especially if it is a repetitive pattern that feels good, the child has difficulty shifting gears and moving on to the next expectation. Like a person who doesn’t know how to end a conversation, so he goes on and on and on.
Sometimes these behaviors are labeled as fixations, compulsive behavior, stereotypic behavior, or perseverations. All of these behaviors/thoughts have in common the difficulty ending the chain once it gets going. Often I see parents and teachers get upset and simply demand the child to stop, only to have the child blow up in an emotional rage. I think we must recognize that many times these behavior patterns are difficult for the child to stop, and they need to “transition” out of them. I have found the following successful in different situations and different children:
1. Some kids simply need a warning of when the behavior needs to stop. They are really not stuck, just hyper-focused and thoroughly into what they are doing. These child often respond to reminding sequence. Parents give 5 minutes, 3 minutes, and one minute reminders that the activity will end and what will occur next. These same children do well with clearly defined start and stop times to the activity. We often use visual timers to clearly define the beginning and ending of the behavior. These children often respond well to a picture schedule that lets them see what is coming up next, so shifting gears is easier.
2. For behaviors that are compulsive or perseverative, another technique can work well. First include yourself briefly in what the child is doing, without asking him to stop or directing him to do something else. Talk about what he is doing and turn it into a we-do. This draws the child’s attention from the task/behavior and onto you, before directing it on to something else. For example, I had a child who would engage in hand washing motions under the running water. It appeared he enjoyed the sensory stimulation, but would get stuck in the action and have difficulty ending the activity. He would get upset when the parent came in and told him to stop. Instead, we first eased the transition by the parent going in and including themselves in rubbing their hands together under the water, and talking about how good it feels. Then once they got the child attention shifted on them, they talked about what to do next, would turn the faucet off and move on. This “including themselves” in the action, interrupted the perseverative response and allowed the child to switch gears.
3. In addition to the above, you can also try creating a concrete ending to the sequence. In the example above, you might include yourself in the action first, then count to ten and turn the water off. I do this a lot with behaviors that include repetitive trials of the same behavior. I will say ok, we will do it five more times than stop. Together we count to five, and then move on. By giving them a concrete stopping point it allows their brain to transition.
4. Often I find that the person might need gentle touch to shift the brain’s focus. So, I will quietly say something to them, and gently touch them on the arm as I include myself in what they are doing. This tactile stimulation seems to jar them from what they are stuck on. This seems to break the neurological feedback loop that allows them to shift.
5. Some getting “stuck” is because the child starts an activity that doesn’t have a clear stopping point. They simply do not know when the task is completed, or when the work is good enough. These children will get anxious because they do not know when something is good enough, or completed. For these children we usually preview all activity ahead of time and let them concretely know when the task is completed.
6. For the hard to “shift” children, we will often follow the behavior that they frequently get “stuck” in with a favorite activity, so it is more motivating to shift (with one of the above strategies). This way we can more easily gain their cooperation in shifting from this perseverative pattern to a another activity that they enjoy.
Between the children’s tendency to hyper-focus attention on something of interest, and have difficulty ending one activity and moving on to the next, it is important to understand that part of this perseveration is a problem in brain functioning. Getting stuck in a neurological feedback loop often needs gentle help in transitioning. However, try and ease the transition, rather than directing the child to stop.
I found the page to have some helpful strategies and information that I believe school staff and families will find helpful. If you are on Facebook, I encourage to visit the page and spend some time checking out all of Bill's great ideas. In particular, related to past posts we have made regarding movement issues and accommodations, I offer you Bill's thoughts and ideas regarding what to do when students with whom you support get stuck:
HELP ME I'M STUCK
(Autism Discussion Page)
Does your child get stuck in an action that they seem to have difficulty shifting from? This might be a repetitive behavior, vocal noise, activity, or thought. With this problem, the child will initiate the behavior, task, or thought and seem to have difficulty ending it. They continue on and on in a fixated pattern.
Our ability to shift from one activity or thought to another is an executive function of frontal cortex of our brain. It allows us to initiate, implement, and stop a behavior fluidly with little difficulty. For many children on the spectrum, these functions are weak. Once a behavior gets started, and especially if it is a repetitive pattern that feels good, the child has difficulty shifting gears and moving on to the next expectation. Like a person who doesn’t know how to end a conversation, so he goes on and on and on.
Sometimes these behaviors are labeled as fixations, compulsive behavior, stereotypic behavior, or perseverations. All of these behaviors/thoughts have in common the difficulty ending the chain once it gets going. Often I see parents and teachers get upset and simply demand the child to stop, only to have the child blow up in an emotional rage. I think we must recognize that many times these behavior patterns are difficult for the child to stop, and they need to “transition” out of them. I have found the following successful in different situations and different children:
1. Some kids simply need a warning of when the behavior needs to stop. They are really not stuck, just hyper-focused and thoroughly into what they are doing. These child often respond to reminding sequence. Parents give 5 minutes, 3 minutes, and one minute reminders that the activity will end and what will occur next. These same children do well with clearly defined start and stop times to the activity. We often use visual timers to clearly define the beginning and ending of the behavior. These children often respond well to a picture schedule that lets them see what is coming up next, so shifting gears is easier.
2. For behaviors that are compulsive or perseverative, another technique can work well. First include yourself briefly in what the child is doing, without asking him to stop or directing him to do something else. Talk about what he is doing and turn it into a we-do. This draws the child’s attention from the task/behavior and onto you, before directing it on to something else. For example, I had a child who would engage in hand washing motions under the running water. It appeared he enjoyed the sensory stimulation, but would get stuck in the action and have difficulty ending the activity. He would get upset when the parent came in and told him to stop. Instead, we first eased the transition by the parent going in and including themselves in rubbing their hands together under the water, and talking about how good it feels. Then once they got the child attention shifted on them, they talked about what to do next, would turn the faucet off and move on. This “including themselves” in the action, interrupted the perseverative response and allowed the child to switch gears.
3. In addition to the above, you can also try creating a concrete ending to the sequence. In the example above, you might include yourself in the action first, then count to ten and turn the water off. I do this a lot with behaviors that include repetitive trials of the same behavior. I will say ok, we will do it five more times than stop. Together we count to five, and then move on. By giving them a concrete stopping point it allows their brain to transition.
4. Often I find that the person might need gentle touch to shift the brain’s focus. So, I will quietly say something to them, and gently touch them on the arm as I include myself in what they are doing. This tactile stimulation seems to jar them from what they are stuck on. This seems to break the neurological feedback loop that allows them to shift.
5. Some getting “stuck” is because the child starts an activity that doesn’t have a clear stopping point. They simply do not know when the task is completed, or when the work is good enough. These children will get anxious because they do not know when something is good enough, or completed. For these children we usually preview all activity ahead of time and let them concretely know when the task is completed.
6. For the hard to “shift” children, we will often follow the behavior that they frequently get “stuck” in with a favorite activity, so it is more motivating to shift (with one of the above strategies). This way we can more easily gain their cooperation in shifting from this perseverative pattern to a another activity that they enjoy.
Between the children’s tendency to hyper-focus attention on something of interest, and have difficulty ending one activity and moving on to the next, it is important to understand that part of this perseveration is a problem in brain functioning. Getting stuck in a neurological feedback loop often needs gentle help in transitioning. However, try and ease the transition, rather than directing the child to stop.
Monday, May 21, 2012
Pretend creatures/Real Voices
Check out these quick claymation vignettes ads (from the UK) which combine the real voices and experiences of people with disabilities which explore the barriers and attitudes faced by people with disabilities every day.
Wednesday, May 9, 2012
The Path to Fitting In
John Elder
Robison is an author and consultant who writes about and speaks of his
success in dealing with his Aspergers. Author of "Look Me in the Eye"
and "Be Different", John provides his unique perspective on the topic of
"The path to fitting in" in this informative and interesting entry at
the Autism Asperger's Digest. For more information about John, visit his website.
Special Ed Teacher Develops Play Date Tool for those with Autism
SpecialPlaydate.com is a way for parents with children on the spectrum to be able to find and schedule safe, rewarding social encounters. Free to members, it’s a new online service that’s
connecting parents with other parents seeking playdate opportunities for
their children with special needs. According to its founder, Jane Hsu,
Special Playdate was created based on the simple premise that "every
child deserves a friend." Read more about this tool created by a special education teacher.
Tuesday, May 8, 2012
Temple Grandin Addresses Increases in Autism Incidence
In an earlier blog post, information about the CDC's recent finding that 1 in 88 people have autism was presented. Recently, Temple Grandin was interviewed and discussed her thoughts about the increase in incidence, the problem with autism awareness — and what the government can do to help parents with kids on the spectrum. Click here to see Temple's interview.
Changes in DSM autism eligibility
There has been much discussion regarding the proposed changes in DSM-V autism diagnostic criteria. Instead of utilizing pervasive developmental disorder (PDD) as a broad umbrella to classify various subgroups (including autism, Asperger's, PDD-NOS), the proposed change eliminates all subgroups and only utilizes one diagnostic criteria -- autism spectrum disorder.
Some feel that such a change will result in the identification of fewer individuals with autism. According to preliminary data presented by the American Psychiatric Association, changes in diagnostic criteria will not reduce the numbers of children identified with autism. Click here to read more about these findings.
Some feel that such a change will result in the identification of fewer individuals with autism. According to preliminary data presented by the American Psychiatric Association, changes in diagnostic criteria will not reduce the numbers of children identified with autism. Click here to read more about these findings.
Thursday, May 3, 2012
Blog Love: April
Can you believe it's May already? We are SO in the homestretch right now! Here are my blog picks from the past month or so - hope it keeps you inspired as we bring this year to a close :)
Assistive Technology Blog
Differentiation Daily
Free Technology for Teachers
Jill Kuzma's SLP Social & Emotional Skill Sharing Site
Assistive Technology Blog
- Portable highlighting bar for the computer: We've all used rulers or laminated highlighting tape to help bring attention to what a student is reading; now you can download one to use while reading on the computer!
Differentiation Daily
- Teaching time management: Great use for a pocket chart from Mrs. T's First Grade; nice visual presentation and easy way to start working on organization with your students.
- Learning about syllables: Great class-made book that doubles as a visual support (hooray!) for teaching about syllables (via Mrs. Larramore at Chalk Talk)
- Tally mark teaching: Nice visual way to teach about tally marks from First Grade Schoolbox, but also very fun and engaging at the same time! What kid wouldn't love to learn about tally marks through stories?
- Homemade calming tool: Simple tool to make, called a Mind Jar from Here We Are Together, to help relax your students. It might even be fun to have time when kids can help make them with you!
- Visual support for telling time: From blog I Do, We Do, You Do, a very sweet visual support for those learning to tell time. Very springy!
- Virtual train ride: Who doesn't know someone who would love this?!? A virtual trip through the Swiss Alps via Google, of course. Enjoy!
- Free assistive tech options: Nice post from Technology Options for Special Needs highlighting free assistive technology options for individuals who need assistance with communication, literacy, etc.
- Clicker alternatives: Blog Holy Paninis! gives a rundown of places to try for clickers instead of always using the classroom type.
- On-line book reading: GREAT RESOURCE - BOOKMARK THIS! We Give Books is definitely a site I am adding to my toolbox.
- Place value cups: Nice, cheap visual support to work on decimals.
- Time to practice in art: interesting post from The Art of Education regarding giving practice time to students before they create the final art project. I thought of a couple of students I know when I read this - helpful idea!
Free Technology for Teachers
- Einstein archives: Cool website with archives of Einstein's work, including drawings and images.
- 9 ways to publish slideshows online!
Jill Kuzma's SLP Social & Emotional Skill Sharing Site
- 5-Point scale resources: Trust me when I tell you that YOU ARE GOING TO USE THIS. Jill provides you with two different resources to use in teaching our students about change via the Incredible 5-Point Scale. Printing it off right now!
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