This text based course is a transcript of the live webinar titled "Strategies and supports for providing early intervention services to children with autism" presented by Tara Warwick, MS, OTR/L.
This is the last in a series of four webinars that I have done on autism. I received some specific questions from the participants last time about some ideas for younger children. I thought it be nice to do a training on strategies more specific to young children with autism. Today we are going to start with an overview on autism. We are going to talk about what the research says about educating young children with autism, and then discuss some specific supports and strategies for working with children with autism, specifically young children with autism. Many early intervention programs are struggling with resources. There are too many children and these programs are always trying to find the most efficient way to serve all the children that need help.
Autism Spectrum Disorders
What are autism spectrum disorders? I love thinking about autism as a hidden disability, and the fact that children with autism do not look any different from others. That can be both good and difficult. Parents can be judged when people do not see the disability in their children. The children can also be held to a higher expectation because it is not obvious what their disability is. I love this quote, “If you have seen one child with autism, you have seen one child with autism.” (Author Unknown) A diagnosis of autism does not mean that they are not individual children. They still have their own quirks, strengths, and weaknesses just like any other child. Keep this in mind as we are talking about the diagnosis of autism.
The current statistics say that 1 in 88 children are diagnosed with autism. However I saw the other day that the CDC said 1 in 50 children are diagnosed with autism. The rate is definitely increasing. Boys are more likely to have autism as compared to girls with a ratio of 5:1. I saw one study that said children with Asperger’s are 12 to 1, boys versus girls. There has been a 23% rise since 2009, a 78% rise since 2007. It is considered the fastest growing developmental disability. All of this information is from the CDC website.
Main Deficit Areas
The three main deficit areas are social skills, communication, and repetitive behaviors. I will not go into the new DSM in this workshop. This information is based on the DSM IV, but the new DSM has social skills as the primary deficit area for children with autism.
Social skills. One of the first things that people look at in young children is whether or not they respond to their name. They also have difficulty in other social areas. An example would be taking something and showing it to Mom. That is another thing we really look at with young children. Are they sharing that enjoyment with their mother or caregiver? Can they initiate interactions with another person? Are they able to maintain a conversation with another person? This conversation can not focus on just what they like. Some children have no problem maintaining a conversation as long as it is about "Thomas the Train" or a subject they are passionate about. If you change that conversation, the conversation is harder for them. How are they in relationships? Theory of mind is seeing the world from another person's perspective or being able to understand that not everyone likes everything that they like. This can be a really difficult concept for them to understand. Finally executive functioning, the high level skills of organizing themselves, filtering what is going on around them, and problem solving, can be impaired.
Communication.There is a range anywhere from a child who is nonverbal to a child who is extremely verbal and does not stop talking. They may use signs, gestures, pictures, devices, or communicate through their behavior, especially if we are talking about young children with autism. Examples would be pulling Mom to the fridge to get their juice, or pulling Mom to the door to let them go outside and play. Many times this is how they communicate. It may also be crying, screaming, or throwing themselves on the ground in order to get a need met.
Many children repeat what they hear which is called echolalia. We had one girl that anytime she ran into a problem, she would say “backpack, backpack". She was repeating something she had heard from the TV. She needed her backpack like Dora, who got it when she needed help.
Another thing that we look at is that they may not point. In our early childhood program, one of the first things that we do with young children (from 18 months up to 3 or 4) is teach them how to point. Pointing is the most basic communication strategy that children use that everyone can understand.
They may not understand body language, tone of voice, or facial expressions. They might also take that language very literally. If you say, “It is raining cats and dogs right now,” they might not understand. You have to be really careful using some of these common statements.
Finally they may have difficulty with processing what they hear. That is why it is really important to use as many visuals and pictures that you can as auditory processing may not be their strength.
Stereotypical/Repetitive behavior and strong interests. Children with autism can have different stereotypes or self-stimulation behaviors. These could be repeated physical movement such as rocking back and forth or hand flapping. They can also have some repeated routines and rituals. I had one little boy who had a certain routine with cars when he walked to the bus stop everyday. If it was a Chevrolet, he tapped the car in a certain way. If it was a Ford, he tapped it in a different way. He felt compelled to go through this routine, and if he did not, he would have a bad day.
Repeated verbal phrases is another type of behavior. They repeat something they hear over and over again. Many times this will increase if they are stressed, excited, have schedule changes, or if they are bored. Self-stim behaviors can increase during these times as well. A teacher may say, "He keeps tapping his teeth." Is he more stressed at this time? Does he know what he is supposed to do? Is there some kind of change? What is going on in the environment that we could change?