POSITIVE BEHAVIOUR SUPPORT STRATEGIES FOR children and adolescents WITH AUTISM SPECTRUM DISORDER
Practical evidence based strategies to help your child achieve better communication, social, emotional, behavioural and learning outcomes
Introduction to Autism Spectrum Disorder
WHAT IS AUTISM SPECTRUM DISORDER?
The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5), published by the American Psychiatric Association, is a handbook used by professionals around the world to diagnose mental disorders. The DSM-5 contains descriptions, symptoms, and other criteria (such as how many of these symptoms must be present) to diagnose a mental disorder.
The DSM-5 classifies Autism Spectrum Disorder (ASD) as a type of neurodevelopmental disorder, which means there is atypical growth and development of the brain or central nervous system, resulting in their abnormal functioning.
ASD is characterised by difficulties in two domains:
- social communication and social interaction; and
- restricted, repetitive patterns of behaviour, interests or activities.
The DSM -5 specifies the following criteria for an individual to be diagnosed with ASD.
Symptoms of ASD
Domain 1 – Persistent difficulties in social communication and social interaction as evidenced by the presence of all of the following symptoms, across multiple contexts, currently or historically:
- Difficulty with social-emotional reciprocity. This can range from abnormal initiation of social interactions and difficulty with normal back-and-forth conversation; to reduced sharing of interests, emotions, or thoughts; to a complete lack of initiating or responding to social interactions.
- Difficulties with nonverbal communication. This can range from poorly integrating nonverbal communication like body language with verbal communication; to abnormalities in eye contact and body language or difficulty understanding and using gestures; to a total lack of facial expressions and nonverbal communication.
- Deficits in developing, maintaining, and understanding relationships. This can range from difficulties adjusting behaviour to suit various social contexts; to difficulties making friends; to a complete lack of interest in peers.
Domain 2 – Restricted, repetitive patterns of behaviour, interests, or activities, as evidenced by the presence of at least two of the following symptoms, currently or historically:
- Stereotyped or repetitive movements, use of objects, or speech, such as lining up toys or flipping objects, repeating the words of others back to them, or repeating idiosyncratic phrases.
- Insistence on sameness, inflexible adherence to routines, or ritualised patterns of verbal and nonverbal behaviour, such as extreme distress at small changes, difficulties with transitioning between places or activities, rigid thinking patterns, or greeting rituals.
- Highly restricted, fixated interests that are abnormal in intensity or focus, such as strong attachment to or preoccupation with unusual objects.
- Hyperreactivity or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment, such as apparent indifference to pain or temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, or visual fascination with lights or movement.
For an individual to be diagnosed with ASD, symptoms must be present at an early age, but may not fully manifest until social demands exceed the ability of the individual to deal with them. The symptoms should cause significant impairment on social, occupational or other important areas and not be better explained by intellectual disability or global development decay.
Presence of Other Conditions
If an individual is diagnosed with ASD, the medical professional will also specify if it is:
- With or without accompanying intellectual impairment
- With or without accompanying language impairment
- Associated with a known medical or genetic condition or environmental factor
- Associated with another neurodevelopmental, mental, or behavioural disorder
- With catatonia
Severity Levels of ASD
An ASD diagnosis includes a severity level, which is used to show how much support the individual needs.
|Severity Level||Social Communication||Restricted, Repetitive Behaviour|
|Level 3 – Requiring very substantial support||
The individual has severe deficits in verbal and nonverbal social communication skills that cause severe impairments in functioning; very limited initiation of social interactions; and limited response to social interactions from others.
For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches and does so only to meet their needs, and responds to only very direct social approaches.
|The individual demonstrates inflexibility of behaviour, extreme difficulty coping with change, or other restricted/ repetitive behaviours that substantially interfere with all areas of functioning. The individual has great distress or difficulty changing focus or activity.|
|Level 2 – Requiring substantial support||
The individual has significant deficits in verbal and nonverbal social communication skills; social impairments are apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social interactions from others.
For example, a person who speaks in simple sentences, whose interaction is limited to narrow special interests, and who has markedly odd nonverbal communication.
|The individual experiences inflexibility of behaviour, difficulty coping with change, or other restricted/ repetitive behaviours that appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. The individual experiences distress or difficulty changing focus or activity.|
|Level 1 – Requiring support||
Without supports in place, deficits in social communication cause noticeable impairments. The individual has difficulty initiating social interactions, and there are clear examples of atypical or unsuccessful responses to social interactions of others. They may appear to have decreased interest in social interactions.
For example, a person who is able to speak in full sentences and engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful.
|The individual’s inflexibility of behaviour causes significant interference with functioning in one or more contexts. They have difficulty switching between activities. Difficulty with organisation and planning hampers their independence.|
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders -5th ed. Arlington, VA: American Psychiatric Association.
Prevalence of and Gender Differences in Autism Spectrum Disorder
Do More People Have Autism Now than Ever Before?
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder, which means there is atypical growth and development of the brain or central nervous system, resulting in their abnormal functioning.
It may seem as though the prevalence of autism has increased in recent years. More people are talking about the condition, and, according to the 2018 Survey of Disability, Ageing and Carers (SDAC), there was a 25.1% increase in the number of Australians with autism in 2018 compared to 2015. It is now estimated that 1 in 70 people have ASD.
However, researchers have indicated that there is no evidence that the prevalence of ASD has increased at all.
Prevalence refers to the total number of individuals in a population who have a health condition at a specific period of time. While it may seem as though more people in recent years have autism, the reality is that previously, many who had the condition were not being diagnosed.
There are several factors contributing to the increase in the observed prevalence of Autism Spectrum Disorder, including:
- Changes in diagnostic criteria
- Changes in assessment processes
- Changes in age at which children can be diagnosed. Now children as young as 18 months can be diagnosed, whereas in the past a diagnosis would only be made at 5 or 6 years of age
- Increased public and professional awareness of Autism Spectrum Disorder
- Reduced stigma
- Improved services for people with Autism Spectrum Disorder
- Evidence of improved outcomes with earlier identification, encouraging people to receive the diagnosis
Gender Differences in Autism Spectrum Disorder
Boys are 3.5 times more likely to have ASD than girls. Even though the symptoms of ASD are the same in both genders, girls with ASD are less likely to be diagnosed or are diagnosed at a later age than boys because the way characteristics manifest and look is different in girls.
Below are some examples of how SOCIAL communication and interaction difficulties present differently in girls compared to boys.
Social communication difficulties are better camouflaged by girls than boys, as girls mimic or copy other people’s social behaviour to appear more socially competent, thus hiding their social difficulties
Often use scripted language (phrases, jokes, topics of conversation) that can hide underlying communication difficulties
Compared to boys, girls internalise (withdraw, shutdown, isolate) more, which can mask their social communication difficulties
Initiate friendships more than boys so that they can fit in and be accepted by their peers. Often have difficulties maintaining friendships
Appear quiet, shy or passive, which is more socially acceptable for girls than boys
Learn how to cope with social situations by masking, observing and coping better than boys in order to fit in and be accepted by others
Below are some examples of how restricted, repetitive patterns of BEHAVIOUR, interests, or activities present differently in girls compared to boys.
Be incorrectly diagnosed with another disorder or several disorders, including Attention Deficit Hyperactivity Disorder, Anxiety, Depression, Obsessive Compulsive Disorder, Schizophrenia, and eating disorders
Exhibit lower levels of disruptive and aggressive behaviour, especially in public settings (school, work, community)
Hold in emotions throughout the day and then explode in safe environments (home) or with safe people (parents, partner)
Agreeable and indiscriminate sociability, which puts them at risk of exploitation
Vulnerable to being bullied face-to-face and online
In turn leads to low self-esteem, anxiety and depression
Observed challenging behaviour resulting from underlying difficulties (coping with change, transitions, sensory issues)
Unaddressed sensory, social, communication, academic and emotional issues lead to avoidance behaviours (school refusal, frequent lateness to work and social anxiety)
Restricted interests (e.g. dolls, books, unicorns or TV shows) and behaviours and stereotypes may not stand out as much in comparison to boys, especially as girls get older
WHAT ARE THE EARLY SIGNS AND SYMPTOMS OF AUTISM SPECTRUM DISORDER?
Autism Spectrum Disorder is characterised by difficulties in two domains: (1) social communication and social interaction; and (2) restricted, repetitive patterns of behaviour, interests, or activities. The first signs of ASD begin to emerge and become apparent within the first two years. For example, you may see that the child is having difficulty with making eye contact, not babbling, not pointing, or using other gestures, not responding to his or her name and does not engage with others.
Some children with ASD start to develop social relationships and communication skills as expected and then regress, usually between 12 and 24 months. In some cases, they stop making eye contact, using language, playing with other children, or learned social skills. Researchers have not found the link between why some children regress or which children are at risk of doing so.
As a parent you are in the best position to monitor your child’s development. Also, as an educator you have a lot of experience with children so you can notice behaviours that are of concern and need further investigation. In Table 1 below, we have outlined expected social interaction and social communication developmental milestones for children aged 0 -2 years. Table 2 outlines the behaviours that are associated with restricted, repetitive patterns of behaviour, interests, or activities. Please remember Autism is known as a “spectrum” disorder because the way the characteristics manifest and the severity of the symptoms will vary greatly from one child to another, hence referring to a “spectrum” or “continuum of disorders.
If your child is not exhibiting the behaviours and skills listed in the table below that are fitting for his/her age, it does not mean your child has a developmental condition instead it simply means it needs to be further investigated. It is also important to note that there is a lot of overlap of characteristics between various conditions. For example, a child with a Social Communication Disorder has similar difficulties with social communication and social interaction as children with ASD, however they do not have the restrictive and repetitive behaviours. Children with Attention Deficit Hyperactivity Disorder may exhibit similarities with reduced eye contact, responding to a name or saying socially inappropriate things caused by inattentiveness, distractibility and lack of impulse control though this doesn’t mean that they lack social awareness of what is appropriate. Children with social anxiety or other anxiety disorders may present with some symptoms suggestive of ASD, as well. They may have reduced eye contact, limited relational attention, be unlikely to initiate interactions and display resistance to change because they prefer familiar routines. These similarities in characteristics can result in some children getting an incorrect or late diagnosis.
Hence for a certain diagnosis of ASD, a comprehensive assessment by a multidisciplinary team of various professionals including a paediatrician, psychologist, speech pathologist and occupational therapist is required to assess the child. They will base their assessment on the criteria outlined in Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This thorough investigation of a child’s symptoms will help rule out numerous conditions and accurately diagnose the condition. This will help when providing and deciphering the best intervention that would most benefit the child.TABLE 1 – Social communication and social interaction
Please note the table does not contain a comprehensive list of all the skills that might be found under each heading.
|Age||Receptive skill||Expressive skill||Social skills|
|0-3 months||He/she reacts to caregiver speaking (e.g. turns head, smiles or quietens)
He/she reacts to loud sounds
He/she calms down or smiles when spoken to and/or picked up
|He/she makes cooing and gurgling sounds
He/she cries to signal needs (e.g. hunger, pain, wet, tired uncomfortable, scared, cold or loneliness)
He/she uses different cries for different needs which are recognised by caregiver
|He/she shows preference for primary caregiver to stranger
He/she quietens in response to familiar voice and being comforted by caregivers
He/she makes eye contact with adult when held close
He/she shows interest in watching faces
He/she smiles to show pleasure in response to social stimulation
He/she shows other emotions such as interest, boredom and sadness
He/she can briefly calm self (e.g. bring hands to mouth and suck on hand)
He/she responds positively to love, affection and touch (e.g. hugs, cuddles and massage)
He/she imitates adult tongue movements
|3-6 months||He/she watches faces with interest
He/she follows moving objects and people with eyesHe/she recognises familiar objects and people
He/she reacts to caregiver’s voice (e.g. turn in your direction, smile or get excited)
He/she l listens when spoken to
He/she responds to changes in tone of voice
He/she pays attention to music and rhythm
He/she notices toys that make sounds
He/she notices other environmental sounds (e.g. microwave, blender, vacuum cleaner)
|He/she laughs, squeals and chuckles
He/she makes babbling sounds by using consonant sounds e.g. da, da, da to get attentionHe/she makes gurgling sounds and blows bubbles
He/she coos more in response to caregiver’s voice
He/she vocalises when happy or upset
|He/she cries when upset and
He/she shows excitement by laughing, waving arms and legsHe/she knows differences between familiar and unfamiliar people
He/she enjoys playing with people, especially caregivers
He/she imitates smiles and frowns
He/she smiles spontaneously (e.g. at oneself in the mirror, at people)
He/she pays attention to own name
He/she makes different kinds of sounds to express feelings (e.g. happiness, upset)
|6-9 months||He/she starts to respond to own name
He/she watches caregiver’s mouth when they talk
He/she gives attention to conversation
He/she appears to understand some familiar and routine words e.g. bed, bottle , car and no
He/she looks at pictures briefly
|He/she babbles by using an increased variety of sounds put together in two syllables (baba, papa, mama, gaga, dada)
He/she imitates sounds
|He/she expresses different emotions (e.g. upset with parent leaves, loss of a toy or holding onto blanket for comfort, happiness when given a favourite treat)
He/she enjoys games like Peek-a-boo, hide and seek and pat-a-cake
He/she shows more comfort around familiar people, and becomes afraid around strangers
|9 to 12 months||He/she reacts to a person speaking especially when name is called
He/she pays attention to where caregiver is looking and pointing to (e.g. following your eye gaze or pointed finger to a toy)
He/she understands up to 50 words for common items and people e.g. car, juice, truck, eyes, and daddy.
He/she starts to respond to simple instructions like “No,” “Come here,”, “more water?”,” give to mummy”
He/she listens to songs and stories repeatedly
|He/she gestures (points) while vocalising
He/she imitates sounds and actions
He/she babbles by putting together many syllables and changes in tone
He/she meaningfully uses and says 1 -2 single words e.g. mama, dada, uh-oh or bed
He/she request objects and actions by using gestures, vocalising, and body language
He/she refuses objects and actions by using gestures, vocalising, and body language
He/she makes comments by using gestures, vocalising, and body language
He/she gains attention by using gestures, vocalising, and body language
|He/she plays simple social games
He/she shows happiness to see parents, toys, or favourite items
He/she can differentiate caregivers from strangers, and gets upset when parent must leave
He/she gives affection and love
He/she responds by turning to look when name is called
He/she imitates some actions (e.g. waving, talking on the phone or drinking from a cup) and simple hand games
He/she understands the word “no”, but may not always listen
|12 months to 18 months||He/she follows simple one-part instructions e.g. come here, sit down, give me cup
He/she pays attention and can point to pictures and familiar characters in books
He/she recognises own name
He/she understands simple questions e.g. Where is puppy?
He/she understands familiar phrases e.g. give teddy a cuddle
He/she understands and point to familiar objects, clothes and body parts
He/she understands more words than what they can say
He/she looks at what is being talking about
|He/she can say 3 to 20 words e.g. mummy, daddy, and a few familiar objects. Intelligibility of the words will varyHe/she expresses no and yes
He/she uses gestures with vocalisations, speech to show someone what they want
He/she imitates new words
He/she makes environmental noises (e.g. animal sounds, transport, and machine sounds)
He/she speaks in 1 to 2 words utterances
He/she uses no and yes correctly
He/she uses own name to refer to self
He/she asks questions by raising intonation at end of phrase e.g. Go park?
He/she uses speech, vocalisations, gestures, or touch to gain attention,
He/she makes a protest by saying no, shaking head or moving away
He/she makes a comment by using speech, gestures, vocalising, or facial expressions
He/she requests action/assistance, by using speech, gestures, vocalising, or facial expressions
He/she answers simple questions e.g. where’s puppy?
|He/she acknowledges when others are talking by giving eye contact, vocally responding, or repeating a word saidHe/she may have temper tantrums especially when tired, hungry or frustrated
He/she seeks comfort from caregiver when angry, upset, scared or sad
He/she shows affection to familiar people
He/she is interested in interacting with children and adults
He/she uses eye contact with children and adults during playful interactions
He/she plays next to other children
He/she may initiate play by handing toys to others but expects them to be returned
He/she engages in simple pretend play
He/she points to or brings an object to show others something interesting
He/she uses a few strategies to self soothe e.g. sucking thumb, getting favourite teddy or asking for a cuddle
He/she engages in joint attention (e.g. points to ice cream and looks at caregiver)
He/she is starting to social reference i.e. seeking and using information from the caregiver to know how to deal with a new or unfamiliar situation
|18– 24 months||He/she comprehends approximately 300 words (but may not able to able to say them all)
He/she understands simple pronouns, action words, body parts and names of familiar objects
He/she understands simple questions, yes/no questions and related two-part instructions e.g. get your water bottle and bag
He/she listens to simple stories with pictures
He/she focuses on an activity for a few minutes
He/she enjoys rhymes and songs
He/she points to objects or pictures when they are named
|He/she can say at least 50 wordsHe/she can name pictures
He/she puts 2 words together (e.g. go car, no tv, more juice)
He/she asks simple questions e.g. ‘What’s this? What’s that?’
He/she imitates sounds words
He/she sings simple songs
|He/she plays near or next to other children and gets excited when with other children
He/she begins to enter a play group with adult assistance
He/she starting to cooperate with other children when playing
He/she mimics real life situations when playing
He/she begins to assert independence (“No!”, “Mine!”), indicate preferences and, wants to try doing things without help
He/she have temper tantrums and may use physical aggression when frustrated
Table 2 – Signs of restricted, repetitive patterns of behaviour, interests or activities
|Stereotyped or repetitive body movements (e.g. tip toe walking, hand flapping, body rocking while standing), use of objects (e.g. repeatedly spinning wheels of a car, lining up objects or opening and closing doors) or speech (e.g. repeating phrases or words or making repetitive noises); moving constantly.|
|Insistence on sameness (e.g. furniture needs to stay in the same place, drinking from the same cup, wanting to wear the same t-shirt everyday), rigid routines for daily activities (e.g. taking a specific route to childcare, having a strict bedtime routine, need to watch a particular before leaving for school in the morning), or ritualised patterns of verbal (e.g. needing to ask people a series of question in a particular order) or non-verbal behaviour (e.g. turning the light on and off three times before entering the classroom).|
|Difficulties with dealing with changes to routines (e.g. crying, screaming, and becoming aggressive if there change in teacher) or environment (e.g. having a tantrum and wanting to run away when asked to eat outside instead of the dining table).|
|Difficulties with transitioning from one activity to another (e.g. going from the playground to the classroom).|
|Highly restricted and persistent preoccupation on an interest and obsession that is abnormal in intensity or focus (e.g. wanting to learn all about washing machines, bus schedules or army).|
|Under sensitivity (hypo-reactivity) or oversensitivity (hyper-reactivity) to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, touch, excessive smelling or touching of objects, visual fascination with lights)|
As you have read this information if it has raised any concerns please speak to your local doctor who can provide a referral to the relevant professional for diagnosis and treatment if appropriate. Research shows that early intervention greatly improves outcomes, so it is important to look for these symptoms when a child is as young as soon as possible. If you would like to learn about more practical evidence based strategies to help your child with ASD achieve better communication, social, emotional, behavioural and learning outcomes please refer to the Positive Behaviour Support Strategies for Students with Autism Spectrum Disorder online course https://behaviourhelp.com/online-courses/positive-behaviour-support-strategies-for-students-with-autism-spectrum-disorder/
CAUSES OF AUTISM SPECTRUM DISORDER (ASD)
In 1943, Austrian American psychiatrist, Dr Leo Kanner, described “early infantile autism” as a distinct clinical syndrome. So, we have known about Autism Spectrum Disorder (ASD) for a long time. However, till the late 1970s and 1980s, ASD was considered a psychological disorder that was caused by poor parenting, specifically the role of the mother. Dr. Kanner coined the phrase “refrigerator mother” to describe the notion that ASD was caused by the mother being cold, distant, unresponsive, and rejecting of her child. However, we now know that it is not a psychological disorder and not caused by poor parenting– it is a neurodevelopmental disorder.
The exact cause of ASD is currently unknown. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is a handbook that is used by professionals around the world to diagnose mental disorders. The DMS-5 explains that there is no exact cause of ASD, which is not surprising given the diversity of its unique presentation in each individual in terms of symptoms, skills, and severity. Instead it’s rather the interaction between the risk factors that may contribute to its development. They include:
- Genetic factors – There is no single gene causing ASD, instead, over hundreds of different genes are involved. Certain genes inherited from the parent can make the child vulnerable to developing ASD. Also, having a parent, sibling, uncle, or aunt with ASD also increases the likelihood of the child having ASD.
- Neurobiological factors – Abnormalities in the genetic code may result in changes in the way the brain develops and works.
- Environmental factors – Parental health (e.g. infections and diseases the mother might have had during pregnancy); maternal use of medications, drugs, and toxic chemicals during pregnancy, low birth weight, childhood illness, food intolerance, and reactions to pollutants may contribute to the child developing ASD.
It is important to remember that there is insufficient evidence to implicate any one environmental factor to the development of ASD; instead, they increase the risk of the development of ASD in children who are genetically predisposed.
Important Note: Vaccines do not cause Autism Spectrum Disorder
An article by Wakefield AJ, Murch SH, Anthony A., Linnell, J., Casson D.M., Malik, M. Berelowitz, M., Dhillon, A.P., Thomson, M.A., Harvey, Pl, et al. (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children [retraction published in Lancet. 2010; 375(9713): 445]. Lancet, 35(9103): 637–641, proposed a link between the Measles-Mumps – Rubella (MMR) vaccine, colitis, and the development of ASD in 12 children.
By 2004, 11 of the contributing authors retracted their interpretation that there was a causal link between the MMR vaccine and ASD in their article, Murch, S., Anthony, A., Casson, D., Malik, M., Berelowitz, M., Dhillon A., et al. (2004). Retraction of an interpretation, Lancet, 363 (9411), 750. Furthermore, a formal investigation by the British Medical Council in 2010 also found that the study by Wakefield, Murch, Anothy et.al. (1998) had not been approved by the bioethics committee. Further investigation revealed that the facts about the children’s histories that were part of the study had been altered and none of their medical records could be reconciled with the descriptions in the published paper. Based on these findings, Wakefield’s licence to practice medicine in England was revoked.
Since then, several scientific studies have consistently and effectively ruled out receiving vaccines and developing ASD throughout the world. For example, in an article by Taylor, L.E., Swerdfeger, A.L. & Eslick, G.D. (2014). Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32(29): 3623–3629. They completed a meta-analysis, combining the results of 10 studies on over 1.2 million children and found no link between vaccines causing ASD.
Promoting self-care, independence and life skills in children with Autism Spectrum Disorder through PARTICIPATION in everyday activities
The International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY) defines participation as a child’s involvement in a life situation (WHO, 2007). Everyday life situations include activities that are planned or frequently occur as part of daily living (Adolfsson, 2011; Dunst et al., 2000).
Participation in everyday activities is viewed as a critical part of a child’s learning and development (Lygnegård et al., 2018). Participation within an activity is described by two essential elements:
- Attendance – Refers to the child being physically present for the activity. Attendance is measured by the variety of activities that are offered to the child, and the number of opportunities given to the child to be present in those routines/activities (Arvidsson et al., 2012; Granlund et al., 2012; Imms et al., 2016; Imms and Adair, 2017).
- Engagement – Refers to the child’s experience of involvement in a situation. The nature and extent of their involvement will contribute to their development (Arvidsson et al., 2012; Granlund et al., 2012; Imms et al., 2016; Imms and Adair, 2017). Participation in an activity can be considered to be the driving force of a child’s development.
By encouraging children with ASD to participate in everyday activities we are promoting their:
- Gross motor development
- Fine motor development
- Speech and language development
- Cognitive/intellectual development
- Social and emotional development
- Sensory development
Depending on your child’s needs, you may have a variety of people assisting your child with ASD. For example, Educators, Allied Health Professionals (e.g. Occupational Therapist, Speech Pathologist, Physiotherapist, Psychologist) and Support staff. By working together with them you can create a PARTICIPATION plan for your child with ASD.
Pinpoint activities to target
Analyse activities into steps
Recognise current skills
Target skills to teach
Identify times to teach
Consider location for teaching
Identify activity materials
Phases of teaching
Tell others to promote consistency
Insert opportunities for generalisation
Own your hard work
Note down skills
Pinpoint activities to target
There are many opportunities for participation in everyday life. Dunst et al., (2000) have summarised activities that a child can participate in into 11 categories.
In table 1, next to each category, write down an activity you would like to encourage your child to increase their participation in to benefit themselves. Remember to start small. You can begin by identifying 1–2 activities and gradually increase to more in time. Select activities that your child finds interesting, engaging and motivating.Table 1
|Category||Activities you would like to target|
|Family routines (e.g. household chores, cooking, shopping)|
|Parenting routines (e.g. bath time, bed time, mealtimes)|
|Child routines (e.g. brushing teeth, toileting, dressing)|
|Physical play (e.g. riding a bike, climbing, swimming)|
|Literacy activities (e.g. reading, storytelling, writing)|
|Play activities (e.g. art and crafts; board and technology games)|
|Socialisation activities (e.g. family gatherings, playdates, visiting friends)|
|Entertainment activities (e.g. dancing, listening to music; going to the zoo, museum and circus)|
|Family rituals (e.g. family video night, visits from the tooth fairy, going to religious services)|
|Family celebrations (e.g. family member’s birthdays, holiday dinners, decorating home during the holidays)|
|Gardening (e.g. doing yard work, planting trees/flowers, growing a vegetable garden)|
Analyse activities into steps
Break the chosen activity into separate, specific and manageable steps.
For example, washing hands is made up of the following steps:
- Turn on water
- Wet hands
- Scrub with soap
- Rinse hands
- Turn off water
- Dry hands.
In table 2, break down the chosen activities into steps.
Recognise current skills
For each chosen activity, identify which steps your child with ASD can already complete, and whether they can complete the step independently or if they require support or assistance. Below is a hierarchy showing the least to most level of support you can provide to your child with ASD to perform a task.
|Level of Support|
|Least support||Independent (I) child can complete the task on their own
Verbal support (VB) child needs verbal suggestions and/or directions to complete the task
Visual support (VS) child needs visual prompts such as gestures, pictures, signing or someone showing them the actions to complete the task
Partial physical support (PPS) child needs some physical assistance to complete the task
Full physical support (FPS) child needs full physical assistance to complete the task
In table 3, next to the steps for each of the chosen activities write out the level of support that needs to be provided to your child.
Target skills to teach
To help your child learn the skills to complete the sequence of steps in the activity you can teach them by using the backward chaining or forward chaining process.
Forward chaining involves teaching steps from start-to-finish (i.e. the child learns the first step →second step→ third step….→last step). Whereas backward chaining involves teaching steps from the last step – to the- first I.e. last step →second last step → third last step….first step)
For example, if the chosen activity is washing their hands, if your child can already turn on the water you may decide to start with forward chaining. You may focus on teaching your child how to wet their hands, and then do the rest for them (i.e. scrub with soap → rinse hands → turn off water → dry hands). You can then work through the hierarchy of support to reduce the amount of support provided to your child to perform a skill, e.g. if a child needs full physical support, is it possible to encourage them to complete a skill with partial physical support?.
In table 4, next to the steps for each of the chosen activities write out the level of support that needs to be provided to your child, barriers and strategies to overcome those barriers.
Remember not all children with ASD will be able to complete all the steps in an activity independently, but the aim is to help a child with ASD progress to perform a skill to their full potential. Once your child with ASD can turn on the water and wet their hands, you can move on to the next step – scrub with soap – and do the rest for them (i.e. rinse hands → turn off water → dry hands). Remember, consistency is the key to learning, so carry out the activity in the same manner each time.
Identify times to teach
Children with ASD need multiple opportunities to practise and learn a skill, so it’s important to identify and schedule times in the day when you can devote your attention to your child. Set aside one or two periods. The length of each period should depend on how long your child can pay attention for. Plan to practice 3-5 days a week. Ensure you set realistic goals so that the teaching does not get too overwhelming for you or your child.
Consider location for teaching
It’s important to have a consistent location for teaching. Choose a room or space in your home to use where you engage in the activity with your child with ASD. Minimise distractions during the teaching period, e.g. decrease background noise by turning off music, TV, noisy appliances; close windows and doors. You can remove visual distractions by clearing away extra items or toys.
Identify activity materials
Children with ASD differ enormously in their rate of growth and development, so equipment (toys, games and activities) should keep pace with your child’s changing needs and abilities. Your child’s interests and abilities should drive the selection of equipment.
Below are some questions you can use to identify activity materials:
- Will it grab your child’s attention and interest?
- Is it too big/small?
- Is it suited to your child’s present abilities?
- How much strength is needed to play with it?
- Can it be used more as your child develops skills?
- Does it include sensory stimuli features (e.g. sound, lights) that your child prefers?
- How is it activated?
- What movements are needed from your child to activate the equipment?
- How much strength is needed to activate it?
- How difficult is it to manipulate?
Phases of teaching
Teaching a child with ASD to participate in an activity can be divided into three phases:
- Observer participation – Your child does not actively participate in the activity but observes you modelling what you would like them to do
- Partial participation – Your child participates in one or more steps of the activity. With your team identify ways of making adaptations or teaching strategies that can help your child participate in the other parts of the activity. Allow your child to have many opportunities for repetition and practise to consolidate the target skill. You can then gradually progress to teaching them more steps.
- Complete participation – The child participates in the entire activity with or without support
Each child with ASD is unique. We need to remain patient and give our child the time to make progress at their own pace. It’s important to recognise and encourage your child for their effort, participation, improvement and displays of confidence in the learning process. Offer reinforcement as a positive way to encourage your child for attempting to perform or performing the skill. Examples of reinforcement include a preferred activity, favourite toy, free time and verbal praise.
Tell others to promote consistency
Share information on what you are doing with other family members to allow your child with ASD to be offered opportunities to learn the skill by everyone.
Insert opportunities for generalisation
Generalisation means providing opportunities to your child with ASD to use their skill in a variety of settings and contexts involving different people, situations and times, e.g. washing their hands in other people’s houses.
Own your hard work
It’s important to give yourself a pat on the back for the great work you’re doing for teaching your child with ASD.
Note down skills
Keep a tangible record (e.g. photos, videos, written descriptions) of what your child can do. This way, when your child goes to other places (e.g. childcare, school, friends’ houses) they can see what your child with ASD can do, have the same expectations and provide your child with the opportunities to participate in activities.
Please remember ‘Success is a journey, not a destination. The doing is often more important than the outcome.” – Arthur Ashe.
So thank you for helping your child with ASD take the first step to reaching their full potential. If you would like to learn about more practical evidence based strategies to help your child with ASD achieve better communication, social, emotional, behavioural and learning outcomes please refer to the Positive Behaviour Support Strategies for Students with Autism Spectrum Disorder online course https://behaviourhelp.com/online-courses/positive-behaviour-support-strategies-for-students-with-autism-spectrum-disorder/
Teaching children with ASD Social Skills
Social skills are a set of verbal and non -verbal behaviours skills that are used to interact or to communicate with one another. These skills are bound by social rules that are created by a community or culture. Social skill competence is measured by how and when a child uses non-verbal and verbal communication skills according to the social conventions of a particular setting.
The terms verbal and nonverbal social skills are explained as follows:
- Verbal social communication skills – You choose the appropriate greeting depending on the person to whom you are speaking, the time and place. For example, at school when greeting a teacher a child might say “Mrs Woods, Good Morning!” whereas if greeting a peer the greeting might be “Hi, Jake.”
- Nonverbal social communication skills – Using the right words is not enough. It is important that the words are said in the right way so that the non – verbal communication matches the words. This skill includes using appropriate eye contact (looking at the person); facial expression (smiling); proximity (standing at an appropriate distance to the teacher); posture (holding yourself in a way to indicate interest); voice (using an audible voice); hands (giving a ‘Hi Five’ to a friend vs. shaking the hands of the Principal).
Social skills difficulties in Autism Spectrum Disorder (ASD) have been attributed to several underlying difficulties. For example, difficulties with understanding non-verbal communication, picking up social rules through observation, Theory of Mind, Executive functioning, communication, central coherence, imagination, rigid/inflexible thinking and gelotophilia (i.e., being laughed at).
Children with ASD need direct, explicit and systematic teaching from the environment, with repeated instruction and opportunities for practicing those skills.
To help children with ASD learn social skills, it is necessary to work out what social skills need to be taught to the child. Teaching social skills can be compared to teaching academics. The first step involves knowing where to start. Below is a social skills profile that you could use to work out your child’s abilities. Please note the profile does not contain a comprehensive list of all the skills that might be found in each of the categories, nor all of the skills that you need to focus on for your child.
|Social Skill||SOCIAL SKILLS PROFILE – Behaviours to consider|
|Non-verbal communication||Gestures – Does the child use gestures to emphasise or convey messages such as waving; head nodding/shaking to indicate “yes” or “no”; pointing; shoulder shrugging; shaking hands and hugging/kissing appropriately?
Eye contact – Does the child orient his/her body towards the person? Look towards the face of the person when speaking?
Facial expression – Does the child’s facial expression match the message (e.g. an excited look when talking about a competition they have just won)?
Proximity- Does the child interact with the other person by maintaining an appropriate distance?
Listening – Does the child give the speaker full attention? Does the child interrupt the speaker? Does the child make relevant comments about what the speaker is saying (i.e., asking questions, repeating words)?
Grooming and hygiene – Does the child demonstrate good personal hygiene habits? Does the child wash their hands, shower, cover mouth when sneezing or coughing. brush teeth and hair on a regular basis?
Voice – Is the child’s voice audible? Is it too soft or too loud?
|Emotions||Identifying emotions in others – Is the child able to perceive and identify emotions by reading the person’s body language and/or or tone of voice? Able to label emotions that others are experiencing such as by sensing when another person is angry by the tone of voice?
Identifying own emotions – Is the child able to describe personal feelings? Label feelings? Discuss how they are feeling?
Understanding the triggers – Is the child able to identify things that can trigger emotions in oneself and in others (e.g., I feel angry when someone takes my things without asking or someone suddenly touches me)?
Expressing emotions appropriately – Is the child able to express emotions in appropriate ways? Identify and understand another person’s perceptions, ideas and feelings, and convey that understanding through an appropriate response? (For example, initially when the child became angry, he would hit the person causing the anger. However, after he received specific instruction on how to effectively deal with his emotion, he would then (1) Stop; (2) Take a deep breath; (3) Relax; and (4) Deal with the issue when calmer.)
Dealing with situations – Is the child able to make decisions about situations in effective ways? (For example, when uncertain about how to deal with a situation, the child needs to stay relaxed and find his teacher or a friend to help him think of an effective solution.)
|Friendship skills||Does the child know how to approach a peer or a group? How to make friends? Keep friends? Be a good friend? Discern who is a good friend and who is not?|
|Talking about their needs||Is the child able to inform others about their needs? Its impact? Modifications others may need to make for assistance? For example, does the child tell the teacher when he/she is disturbed by classroom learning distractions?|
|Conversational skills||Topic – Is the child able to initiate? Maintain? Elaborate? Extend topics appropriately. Is the child able to end the topic of conversation? Change topics appropriately?
Content – Is the content appropriate and relevant to the situation? Does the child converse with others to get to know more about them or only talk about him/herself? Is there an understanding of social boundaries, or does the child frequently discuss inappropriate things?
Turn-taking skills – Is the child able to take turns as a listener? Speaker?
Clarification Requests – Does the child ask for explanations of information when it is unclear?
|Social etiquette||Greetings – Does the child greet people appropriately?
Social Courtesies – Does the child use social courtesies appropriately (i.e., Please, Thank you, and Excuse me)?
Situation specific – Does the child use appropriate language according to time? Place? Person? Are behaviours appropriate to a specific situation (i.e., a restaurant)? Does the child know which behaviours are private, such as scratching, twitching, rocking and swaying?
|Playing||Playground – Does the child know where and which games to play outside the school? How to use playground equipment? Does the child play with others or alone?
Games – Does the child know how and when to play the game? Necessary equipment? Game rules? Where and with whom to play the game? How to share?
|Independent travel||Is the child able to tell his/her destination to the bus or taxi driver? Able to ask the driver to indicate when they arrive at the destination if needed?
Does the child know how to ask for assistance? Directions?
Know how to pay for the bus or taxi?
|Relationships||Types – Does the child understand different types of relationships (i.e., family, friendships, or employer/ employee). Display appropriate levels of affection according to the relationship with the other person?
Dating – Does the child know how to choose a date? Where to go? What to talk about? Appropriate public dating behaviours?
Sexuality – What are socially acceptable appropriate and inappropriate public sexual behaviours? Has the child been provided with information in an understandable manner about sex, sexual relationships, reproduction and birth control, menstruation, managing periods, sexually-transmitted diseases, and sexual abuse?
|Telephone Skills||Is the child familiar with the different parts of a telephone? How to make a phone call? How to answer the telephone and take messages? Whom to contact in case of an emergency? How to carry on a phone conversation with friends?|
|Internet Skills||Does the child understand and use Netiquette? Does the child understand the implications of communicating on the Internet? Does the child know how personal information should be provided online? Does the child know what to do if someone is interacting with them inappropriately?|
|Leisure time||Within school – Does the child know available leisure activities for free time? Where games and equipment are located or stored? How to use the items appropriately and independently? Does the child need to have organized activities for leisure time?
Outside of school – Does the child have hobbies or creative interests at home? Know where to get information about potential leisure activities? Have the ability to join in these activities?
|Conflict resolution Skills||Can the child identify situations that can cause a conflict? Does the child know with whom to discuss conflicts? Can the child provide the relevant information about the conflict-causing situation (i.e. Who? What? Where? When? How? Why?)? Think of solutions and identify the best one? Have the skills to resolve the conflict? Know how to prevent the situation from arising again?|
|Eating Out Skills||Does the child know or can s/he ask for assistance with:
In thinking about how to teach social skills systematically, you can employ the steps identified in this instructional sequence as a guide to facilitate learning.
Step 1: Provide a rationale – Help the child understand “why” the social skill is useful.
Step 2: Provide modeling – As you demonstrate the skill, provide the child with specific rules or steps involved in the skill. Many children with ASD are not easily able to understand the verbal messages that you use to shape their behaviour e.g. the steps they need to follow, or your constructive feedback. The use of visual systems (e.g. social script, Social Story™) can supplement this verbal information and clarify the information. Also, for many children, it is helpful to provide an example of someone using a skill correctly and incorrectly by discussing the actions, reactions and consequences.
Step 3: Provide guided practice – Provide the child with opportunities to practice or rehearse skills in staged situations that simulate the actual situation. Provide the child with multiple opportunities to practice the skill in small, structured groups with same-age peers in a comfortable, fun, and supportive environment. Initially you may have the child practising these skills with an adult and then proceed to practising with peers. You can use a variety of teaching techniques to help your child learn social skills, such as:
- Coaching the child through the steps
- Role playing
- Videotaped interactions
- Structured interactions
All these activities require you to freeze the activity at key points ask questions, comment on the skills and identify strategies on how to fix the situation. Having practised the words and the movements associated with an interaction, the child is more likely to be comfortable in the applied situation. Remember to support your child’s learning by providing positive encouragement and praise. As the child develops their skills and becomes confident, minimise your assistance so that the child can participate independently as possible.
Step 4: Teach self-regulation – Self-regulation is the ability to evaluate one’s own behaviour and emotions in terms of their appropriateness to regulate them accordingly. Self-regulation includes skills such as self awareness, self monitoring, self evaluating, self managing, and self reinforcing oneself. Self-monitoring involves conducting an assessment of one’s own behaviour as appropriate or inappropriate. Initially you may need to prompt the child to become more aware of their own behaviour. It is important to encourage the child with ASD to self-evaluate skill performance and think of strategies for doing things differently. This process helps the child with ASD with the promotion of skill maintenance and growth through self-monitoring. Strategies such as audio taping, videotaping, role-playing social situations, visual systems, structured games and activities and using individualised stories can promote self-regulation.
Step 5: Promote generalisation – Generalisation is a form of a critical yardstick by which the effectiveness of the skills and strategies can be informally gauged in terms of how well the child with ASD can adapt the skills taught into their everyday life settings. Generalisation programming should be considered from the start and become a part of the social skills instruction program. It will be important to provide opportunities for the child with ASD to use newly acquired social skills in a variety of settings, people, situations and time. The goal at this stage of instruction is for the child with ASD to use the social skills they have learned in a variety of situations, helping them build satisfying relationships with their peers. They are then motivated by their successes, and the joy they experience in developing relationships, and this promotes further building of their skills.
It is important to remember that learning how to use social skills is a life-long process. It involves the continuous refining and adaptation of skills according to the expectations, people and situations that we encounter.
If you would like to learn about more practical evidence based strategies to help your child with ASD achieve better communication, social, emotional, behavioural and learning outcomes please refer to the Positive Behaviour Support Strategies for Students with Autism Spectrum Disorder online course https://behaviourhelp.com/online-courses/positive-behaviour-support-strategies-for-students-with-autism-spectrum-disorder/
POSITIVE BEHAVIOUR SUPPORT STRATEGIES FOR CHILDREN AND ADOLESCENTS WITH AUTIS SPECTRUM DISORDER
This online, self-paced course that will equip you with a toolkit of practical strategies to help your child with ASD achieve better communication, social, emotional, behavioural and learning outcomes. You’ll also learn a range of behaviour management strategies to effectively respond to challenging behaviour and develop a prevention plan with the Behaviour Help app.
AT THE END OF THIS COURSE YOU WILL HAVE:
- Free copy of ‘Positive Behaviour Support for Students with ‘Autism Spectrum Disorder’ course book
- A toolkit of practical strategies to assess, manage and prevent challenging behaviours in children with Autism Spectrum Disorder
- Actionable tools for developing a behaviour support plan that you can apply immediately with your child in your setting
- Lifetime access to the Behaviour Help app, allowing you to develop a behaviour support plan for a child with Autism Spectrum Disorder
- A certificate of participation for 5 hours of professional development
This course is accredited by the Teacher Quality Institute of ACT.
WHAT YOU’LL LEARN
This online, self-paced course is divided into three modules.
Module 1 – Introduction to Autism Spectrum Disorder
- Defining ASD
- Subcategories of ASD
- Characteristics of ASD
- Impact of Characteristics on Social Communication, Learning and Behaviour
- Onset of ASD
- Diagnostic Process
- Causes of ASD
- Prevalence of ASD
Module 2 – Positive Behaviour Support
- Learn about data collection (intensity, frequency, duration)
- Complete a functional behaviour assessment
- Identify triggers and functions of challenging behaviours
- Learn and identify safe and appropriate behaviour de-escalation management strategies
- Learn and identify appropriate behaviour minimisation and prevention strategies
- Develop a customised behaviour support plan
- Learn and identify appropriate strategies and tools for helping a student develop cognitive, communication, behavioural and social skills
Module 3 – Positive Behaviour Support and Autism Spectrum Disorder
- Help students with ASD cope with change
- Help students with ASD cope with unstructured times
- Help students with ASD cope with transitions between activities, people or places
- Help students with ASD develop communication skills
- Use visual communication systems to help improve communication, play and a positive identity
- Develop an Individual Education Plan
HOW TO ENROL AND RECEiVE YOUR RESOURCES
Teachable – Click on START THIS COURSE to begin the course through Teachable, where you’ll be required to pay the course fee of $165 via credit card. If you would prefer an invoice or have multiple participants please email firstname.lastname@example.org
Once enrolled, you will receive a Welcome email with the following information:
Login Details for the Behaviour Help App
Amazon voucher Confirm the email address you would like the Amazon voucher to be sent to so you can download a free copy of the coursebook Positive Behaviour Support Strategies for Students with Autism Spectrum Disorder: A step by step guide to assessing, preventing and managing emotional and behavioural difficulties on Amazon Kindle.
Course tasks to complete and send via email to email@example.com
- Parents and caregivers
- Childcare staff
- Primary and secondary educators
- Teachers assistants
- Disability staff
- Youth and community staff
- Allied Health Professionals
About your trainer
Dolly Bhargava completed a Bachelor of Applied Science in Speech Pathology and a Master of Special Education, Over the 20 years she has found her passion for supporting individuals with emotional and behavioural difficulties (EBD). She has created this online course to equip people who support individuals with EBD to develop knowledge, skills and tools to transform the lives of the individuals they support.
Learn more about Dolly Bhargava and Behaviour Help