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Invaluable Solutions : Ideas on Autism: Building sensory communication with your child
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Posted by sylvia on Saturday, August 06, 2005 (11:09:35)
PregnancyAndBaby.com
By Kerstin Potter MS OTR
Sensory Preferences:
Jessica is four and likes to rock; if not involved in other things, she sits in a corner holding her favorite toy and sways back and forth. Billy is three and likes smells; rather than greeting a person by making eye contact, he will reach for the clothing and sniff it. When Jamie, five years old, is asked to attend to a table-top activity, he responds by flapping his wrists and waving his arms. Luis, at six, can't stand to be touched; if another child brushes against him, he throws himself into a beanbag chair and covers himself with a blanket.
Why are these children doing such unusual things? While parents and experts agree that many of our children with Autism-related conditions show unusual behavior, there are various interpretations as to why. Some will call these behaviors "maladaptive" and will aim to eliminate them through behavior training. Some believe that the child is seeking attention, and will ignore them.
Professionals using a sensory processing/integration approach, however, interpret the behaviors as a language which children use to communicate their wants and needs to those around them. If we can learn this language, we can start building new ways of communicating with our children.
Each of us has a unique way of taking in sensory information from the world around us and from within our bodies, so that we can interpret what is going on, and relate to the world. As babies, most of us enjoyed the touch and smells of our parents, and the sensation of movement as we were being rocked or driven in a car. We loved feeling our limbs move and spent hours kicking our legs in the air. We then added the ability focus on sounds around us, distinguishing voices, recognizing music, and knowing to ignore background noises. While we could always see, we gradually used our vision more effectively to identify the world out of reach, - people, toys, and the exciting sights on a stroll to the park.
This last sensation, vision, proved to be so good at providing important information that we focused on this more and more, using vision as our primary conscious means of learning about the world. Therefore, visual input became a priority; eye contact became essential for communication, recognizing letters for learning, and watching our step for safety.
Children with Autism have their own priorities. They may prefer the sense of smell over vision, like Billy, who would rather smell than look at a person. Or, like Jessica, they would much rather rock back and forth than attend to what is being said, since the sensation of body movement really feels good to them. While this may look unusual to the outsider, it provides us the opportunity to understand our children better.
As parents and teachers, we need to recognize these behaviors as expressions of preferred sensory channels, and use them to build our communication, in other words, develop our skills at speaking "Sensorish". The child is saying to you: "This is my language; this is how I relate to the world."
What you can do:
How can you use "Sensorish" to communicate?
First, sharpen your observation to recognize the preferred channel. What arouses your child's interest? What does she do to comfort herself? We already identified that Billy's channel is the sense of smell, and Jessica's the feeling of movement. Here are some other examples: A child who likes to hop up and down may need some trampoline time with you, a child who scratches or hits himself may ask to be held closely or be massaged.
Once you have identified the preferred sensation, there are two ways in which you can begin to use this, by "switching channels", or by "coupling channels": By "switching channels", you may move your communication to the child's preferred channel.
If Billy would rather smell than look, let's provide him with interesting smells when you play with him. You can use different aromatic essences, creams, magic markers with fruit smells, or add aromas to toys by spraying them with essential oils, etc. (of course, check out any allergies before using this, and use only if the child is not mouthing toys). You may be surprised by your child's level of interest, attention span, and motivation to participate in play with you.
By "coupling channels", we describe the process by which you combine the child's preferred channel with another channel.
If Jessica would rather rock than listen, let's combine the two. Tell her stories, or sing songs, while she is in your lap in a rocking chair, or in a swing. Gradually, you may find that you can reduce some of the movement, and she may show more interest in just listening.
Now that you know what sensory input "turns your child on", you may also use sensory activities as a reward for a difficult task, for example, application of special skin cream after washing hands independently. And finally, you may choose to just spend some special one-on-one time with your child engaging in activities in the sensory language that you both understand.
Sensory Diet:
While vision appears to have become the dominant "sensory channel" in our society, it is important to remember that we continue to use all of our other senses. In fact, it is essential that we all get a balanced "sensory diet" every day. For instance if we sit still all day long in front of a computer, we will feel the need to stretch and "feed ourselves" the sensation of limb movement through a brisk walk of work-out in the gym. On the other hand, if we take in too much of a particular sensation, such as the overwhelming visual stimuli of rush hour traffic, we may have to - once we get into the driveway - digest the experience by closing our eyes and tuning everything out.
Children with Autism often live with an imbalance in sensory diet. Because of the unique way their nervous systems identify and interpret sensation, they may react differently to sensory experiences than you would expect.
Jamie, whom we met at the beginning of this article, may not be getting in enough sensation to keep him in an alert state. When he is confronted with a task that requires attention, he may flap his wrists and wave his arms to "wake himself up".
Luis, whom we also met earlier, perceives being touched lightly on the shoulder as very irritating, and even threatening – more sensation all at once than he can handle. The intensity of this experience is comparable to our hearing chalk squeak on the blackboard – it stops us in our tracks and we will do anything to make it go away! If we watch our children carefully, we can find clues as to what they have figured out to balance their sensory diets.
Some have ways of alerting themselves, so that they can be ready to interact. Some have identified ways of "make it go away", and to calm themselves down. Unfortunately, many of these behaviors appear unusual to the outsider and are disruptive to other children, and some are even harmful (such as head banging, or pulling hair). Therefore, based on the clues they give us, we need to offer our children alternate means of providing themselves the sensory input they need to balance their diet.
What you can do:
Observe what your child does when he gets upset or overwhelmed, identify the sensory channel that works for your child, and think of ways to provide the desired "sensory food". Let's look at some examples by starting with Luis and Jamie:
We have heard that Luis likes to throw himself in a bean bag chair when he is touched. Aha! Now we know it is the deep pressure sensation that helps Luis "erase" the bad feeling of the initial touch! We can now provide that sensation in more appropriate ways; through deep bear hugs, by teaching him how to "rub himself down" using a terry cloth, or by providing a heavy "comfort jacket".
Jamie, as we have observed, likes to flap his wrists and wave his arms when he is asked to do table-top work. Now we know that pressure and movement to the joints makes him feel more alert. We can offer him squeezable toys, such as stuffed animals or balls, provide play dough or thera-putty, or ask him to help with household activities that involve pushing or pulling heavy objects, such as setting up furniture, pulling a garden cart, or taking the garbage can to the curb.
Here are some other examples:
Does your child bang her hands against her ears?
She may be overwhelmed with sounds and benefit from ear muffs that block out noises. Does he run into a corner and hide his face? He may need a quiet area, such as a refrigerator box with pillows, to "regroup". Does he pull at his hair? He may need intensified tactile sensation, such as a body rub or a "brushing down".
Summary
In this article, we have looked at using sensation as a way to increase our communication with our children. Identifying the preferred sensory channel can help us develop skills in "Sensorish". By either "switching channels" or "coupling channels", we may discover new ways to make contact. By observing a child's reactions to overwhelming stimuli, we can help him develop safe and effective coping mechanisms.
In summary, our children are giving us clues all the time; we just need to learn to read them! By opening our eyes to the world of sensory communication, it is hoped that this article has provided some ideas to help you and your child understand each other in new ways.
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Invaluable Solutions : Controlling self-injurious and assaultive behavior in autism
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Posted by Sylvia on Tuesday, January 06, 2004 (12:50:06)
Bernard Rimland, Ph.D.
Nothing is more difficult for the parents of autistic children to tolerate than self-injurious and assaultive behavior (SIB/A).
SIB/A behaviors are unpleasant to observe, to think about, or to discuss, but they do exist, and must be dealt with. Some autistic children hit their heads against walls or floors so hard that they have fractured their skulls, detached their retinas, or caused deafness.
Others hit themselves with their fists or their knees so hard that they have broken noses, deformed ears, and even blinded themselves. Some children bite themselves and others, and hit other children and their parents with such violence they have broken bones.
The first approach, when one is confronted with SIB/A, is to try to determine why the child is engaging in those activities. Is it pain or frustration that is causing the child to strike out at himself or at others? One nonverbal child was severely self-injurious from age 2 to 18, when it was discovered that he had been suffering from a very painful mastoid infection.
Many medical examinations had failed to disclose this source of severe pain. Try to find a physician who is the parent of an autistic or other handicapped child to do an extremely careful medical exam to determine if there is a cause of pain underlying the intolerable behavior. Tim Buie, M.D., has found that undetected stomach pain has caused SIB in his autistic patients.
A good deal of time and attention have been devoted to methods of dealing with these terrible problems, including:
1.Behavior modification using positive enforcement only. This approach is certainly to be recommended if and when it works, but there are many instances when it does not work. A review of the literature by the Association for Persons With Severe Handicaps (TASH) found that positive reinforcement is effective approximately 60% of the time. We are concerned with the other 40%.
2. Aversives. While many people are ideologically opposed to aversives, a blue-ribbon government panel investigated this problem and concluded that there were many instances where aversives were the preferred approach, in those many cases where positive reinforcement does not work.
3. Drugs. Many drugs, including most recently Naltrexone, have been partially effective in some cases. However, most drugs bring about their own problems, which are by no means trivial.
4. Correcting body chemistry, through the use of nutritional supplements, or by detoxifying the body of toxic elements such as mercury, is an under-utilized alternative.
Detoxification: Amy Holmes, M.D., who has treated many hundreds of autistic children for mercury poisoning, reports that while the best improvement in terms of speech, sociability, cognitive gain, etc., is seen in the younger children, teenagers often show a marked and very welcome reduction in SIB/A when the mercury is removed.
Vitamin B6 and magnesium, and DMG (dimethylglycine): Over the past 40 years I have encountered a great many cases of severely SIB/A individuals who have responded wonderfully well to nutritional supplementation, particularly high dose B6 and magnesium, and DMG. Surprisingly, these improvements have been seen not only in autistic individuals, but in girls with Rett syndrome and boys with Fragile X syndrome, as well as children with Angelman syndrome. A few sample cases:
Case 1: Anthony, an 18-year-old autistic man in England, was so violent that he had to be institutionalized. At the institution he broke seven windows in three minutes, and tried to attack women sexually, requiring severe restraints. Drugs did not work, and his mother, who runs an organization to support research in autism in the U.K., contacted me for help. I suggested high-dose vitamin B6 and magnesium. The result was miraculous.
When Anthony was taken on a train trip, his parents forgot to bring along the vitamins. The next day, he again became “a raging beast.†I was invited to speak at the institution where Anthony resided, and took the opportunity to meet him and discuss his case with the staff. All agreed that Anthony had shown remarkable improvement when given the high-dose vitamin B6/magnesium.
Case 2: Some years ago I was asked to speak in Caracas, Venezuela, by Dr. Lilia Negron. Dr. Negron introduced me by telling the audience, and me, about an autistic young man whose mother had come crying to Lilia’s office trying to get help for her son. He was about to be evicted from the third mental hospital, since even massive amounts of drugs did not control him, and he was too violent to be kept in the hospital.
Dr. Negron tried the B6 and magnesium as a last resort. The young man calmed down quickly. Dr. Negron reported at the meeting that she had recently visited the family, and had found him to now be a pleasant and easy-going fellow who sang and played his guitar for her.
Case 3: The boy’s mother told me that he was considered to be the most severely self-injurious and assaultive autistic person in her state-a very large state. Nothing would stop his self-injurious behavior. The drugs he was given had such an adverse effect on his heart that increasing the dosage would probably kill him, yet his self-injurious behavior continued. The mother was so distraught that she had seriously considered killing both her son and herself because she could no longer tolerate the situation.
She tried the B6 and magnesium, with incredibly good results in a short time. She was elated. However, she called me back a year or so later to tell me that he had started hitting himself again. I suggested she switch to P5P, a different type of vitamin B6, rather than pyridoxine hydrochloride, since that might make the difference. I have not heard from her whether that change helped. Research is needed.
Case 4: Michael was a 180-pound, 18-year-old autistic young man who had broken his mother’s jaw and beaten his father so badly that he had missed work for several days. The police had been called on a number of occasions, when he flew into one of his rages. Ed Kitt, the principal of the school in Las Vegas that he attended, told the family to contact me for advice.
I suggested the B6 and magnesium, as well as DMG, and the results were nothing short of miraculous. Michael’s very good and pleasant behavior has continued now for a number of years. He continues to take massive amounts of B6 and magnesium (1500mg of B6, 700mg of magnesium) and 18 DMG tablets per day. The father told me that these nutrients are expensive, but he is glad to pay for them. They are less expensive than the drugs he had been buying, and certainly much more effective, safer, and more helpful for his son.
Rett’s Syndrome: Several years ago I received a phone call from a mother telling me that her teenage Rett’s syndrome daughter was gouging her eyes, and hitting herself very severely, with great likelihood of bodily damage. I suggested the B6 and magnesium, and DMG.
Several months later I got an excited phone call from Kathy Hunter, president of the Rett’s Syndrome Association, who told me about a Rett’s syndrome girl who had been severely self-injurious, and had been helped enormously with nutritional supplements. She gave me the mother’s phone number. When I called, it turned out to be the mother whom I had spoken with earlier.
Angelman’s Syndrome: A number of mothers who had attended a convention of the Angelman’s Syndrome Association called to tell me that they had been told of an Angelman’s child who had been hitting himself, scratching and biting his mother, and generally being quite aggressive. DMG brought about excellent results, so other mothers also tried DMG and got the same results.
I asked them the name of the national authority on Angelman’s and wrote to that physician, asking if he would be willing to collaborate on a study of DMG’s effects on self-injurious behavior in Angelman’s syndrome. I have never received a reply.
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Invaluable Solutions : COMMUNICATION AND VIOLENT AUTISTIC BEHAVIOUR
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Posted by Sylvia on Tuesday, January 06, 2004 (12:36:22)
Dr. James D. MacDonald
How to Communicate when my child is acting:
Physically or Socially verbally abusive, Overly negative or Inappropriate
· The problems: Many children show more negative behavior when they get your attention for it.
Many parents feel they need to talk to a child who acts badly, either to punish them, or reason with them or teach them how to behave.
These parents often do not realize that their talking is a powerful reinforcer (reward) that will increase the child's undesirable behaviors.
· Remember: Talking to a child after he misbehaves is much like:
· Giving him a $20 dollar bill for each misbehavior.
· Giving candy to a diabetic child.
· Teaching him to expect the world to reward his bad behaviors.
So, when you think you are getting rid of the behavior, you may be doing just what will increase it and make it worse.
· Example: John is a 5-year-old boy who began to talk at 3 ½ years of age. His parents worried he would never talk. Now, they attend to everything he says, and at this point most of his talk is loud demands, abusive criticisms, and angry resistances, along with hitting, spitting, and destroying things.
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Invaluable Solutions : CASE STUDY WITH A PREVERBAL AUTISTIC BOY
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Posted by Sylvia on Tuesday, January 06, 2004 (12:21:23)
Dr. James D. MacDonald
The following is a report on three years of the ECO program with a mother and a highly resistant autistic boy. Andrew is now 8 and talking in sentences. He is still sensitive to over stimulation but is becoming to be more spontaneous and conversational in his language,
Andrew, at age two-and-a-half years, came to me after being diagnosed by a team of a psychologist and a pediatrician as autistic. When I observed Andrew in our clinic, he was non-verbal, non-interactive, highly perseverative in actions and sounds, and highly resistant to touch and language. Andrew screamed intensely for from two to ten hours a day.
He resisted personal contacts as if they were violent abuses. He was extremely sensitive to sounds and to almost any unexpected event. He refused to allow me to approach him. In order to calm him, I talked with the mother from a distance of about fifteen feet. I learned early to read Andrew’s boundaries and to enter them only very slowly.
So, I asked myself, can I help a child who won’t allow me near him? Soon, I realized the answer was yes, because Pam, his mother, was very open to learning how to play in Andrew’s world. She had no question that Andrew could do much more. She realized he knew many things but also knew he responded to many traditional teaching approaches with noisy, frightened retreat.
A major problem here was that Andrew had such a low rate of interaction with people and such a narrow range of activities that he appeared locked in a world that kept him from learning anything from others. My first task was to explain to Pam (and provide related readings) that language comes from close back and forth contacts with people; and that Andrew needed many skills before we could address talking directly. He needed to stay in interactions with people who were willing to act in ways he could and who placed no demands on him other than to stay in back and forth contact. He needed to learn he could survive interacting with people.
Pam soon understood that for Andrew, staying in interactions was as critical for his coming into relationships as insulin is for the health of a diabetic. In my view, the world for Andrew was over stimulating to the point that he not only tuned out, but imposed such violent self stimulation that he was rendered out of perceptual contact for up to several hours. So, the dilemma was how to keep Andrew in interactions that seemed to put him into a state in which he could not hear, see, or cooperate enough to learn anything but to escape.
Once Pam realized that Andrew had to stay in interactions, she learned a few things: how to act like him, to reduce her language and her demands and keep just one goal in focus--to keep Andrew physically interacting back and forth more frequently and for a little longer as time progressed. Pam practiced as I sat fifteen feet away coaching her to do the following: act like Andrew then wait, gently keep him with her, wait for him to do anything positive, even the smallest steps in sound or action, then do it like him and wait again to repeat the cycle.
The activities involved exchanging any sounds, actions or physical objects (like a doll) back and forth, teaching him three things: one, that he could survive interactions; two, that there was no option to staying; and three, that if he did just a bit more he would be free to explore as he wished.
A major breakthrough came in about four months when he started staying without being physically held, and initiating exchange games on his own. He was still interacting with some anxiety and resistant to staying with people, but he was staying and his mother was experiencing for the first time that she could have some effects on him and that he would finally give back some of her playful contact.
Pam’s attitude was inspiring to watch. Andrew vehemently resisted for several months, but Pam took the smallest gains and expected more. She often said something along the lines of "I don’t care what he does, but he’s going to do more of it and he’s going to do it with me."
A unique and forceful feature of Pam’s was her non-judgmental humor. She didn’t take his rejections personally and she frequently laughed when she kept him with her as if to say "I know you don’t want to stay, but I’m going to be so entertaining that you will." Pam learned to ignore much of Andrew’s disruptive behavior and persisted in getting him to respond in any way he could. She did not view Andrew as doing anything wrong; rather she saw it as her responsibility to get him into her world by first getting into his.
When I commended her on her persistence through months of plateaus, setbacks, and downright disturbing periods, she said "I’m going to do whatever I have to--I know there is a bright little boy in there and I don’t expect it to be easy."
And it clearly wasn’t easy. New people, situations, activities and most changes would invoke setbacks and sometimes monumental disturbances in their family of five. When I noticed Pam pushing herself without much response from the boy, I prescribed a break for her. Then she learned that forgetting about interacting for a while led her to see how much she had learned to do habitually. She was pleased to see Andrew initiate and keep her interacting when she took a little vacation from focusing on it.
Once Andrew began to stay in interactions, that is, to take turns both imitatively and with behaviors of his own, I encouraged Pam to begin to hold out for more sounding. When he took a turn, by clapping hands or rolling a ball, Pam would wait for any sound before she took her turn. We discussed how effectively Andrew had been communicating with her with tugs and pulls and soundless signs. He needed to learn that sounds are more effective communications.
For now, he made sounds more for apparent self stimulation than to communicate. Until then, he didn’t know the powerful positive effects sounds could have. And sounds were not quick to come. It took much waiting and prompting as well as having Pam coach the family into the habit of imitating all of Andrew’s sounds even if he was in a separate room. It took months to show Andrew that sounds got people’s attention most efficiently. By now, he was choosing to play with his brothers and parents, of course briefly and often on his own terms. But he was joining the family.
Pam continued to map Andrew’s progress on forms much like the ECO Basics. She regularly monitored both how he was doing and how she was doing. Once her watching, waiting and keeping him there were stable habits, I began to teach her how to help him move from sounds to words. She learned to treat his sounds and movements as his own special language and her job was to translate his actions and nonverbal communications immediately into single words. She learned that the exact the time he was doing something or communicating with someone was the best exact time for him to learn a word for it.
We had to do some work to keep the family from asking too many questions which simply did not show him how to talk. We practiced talking to Andrew not just to be understood but to show him what to say at that moment. Andrew was understanding increasingly more words, but he was not using them. Pam taught her family to reduce their questions and long sentences and to become a family of translators as if Andrew was a visiting foreign-speaking child.
Now, three-and-a-half years later, Andrew is five and still coming into the world of his family and peers at school. He’s talking more frequently and appropriately; he now needs to learn to stay in conversations. He responds much less with fight and flight but he still needs to learn about people boundaries as he can be a pretty rough play partner. Recently I visited with Andrew and his father. His dad admits not seeing the problems his wife experienced. He is excited with Andrew’s social gains and feels they have a strong, playful relationship in which he, the dad, gets a lot from Andrew who used to be a stranger to him.
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