Wednesday, May 23, 2012

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!”