27 September 2013
Change Our Ways ~ Autism
http://www.autismsupportnetwork.com/news/autism-and-changing-your-ways-27892422
Autism and changing your ways
Pamela Crooke, PhD, CCC-SLP
For most of us, the drive to change our own behavior emerges on or around January 1st with the dawn of a new year and new possibilities for self improvement. Lose a little weight, stop smoking, exercise more, and eat leafy greens seem to be among the favorites. Most of us are pretty conservative and only select 1 (maybe 2) goals to tackle each year. After all, we are only human and it takes a lot of thinking to change a pattern or ingrained routine. If you’re diligent and work hard, you might see a change but for most of us….it’s an exercise in futility by the time March 1st comes along. Why does that happen? How do we lose our “oomph” and why do we slip back into our old, familiar ways? Why can’t we learn to change our ways? These are all questions that we ought to be asking, but rarely do. Instead, we wait until the following year and begin the process all over again. Why?
Because changing a behavior is REALLY hard, even when we’re highly motivated to do so.
If changing behavior is so tough for us…consider for a moment the number of IEP goals your child or student currently has. Most of the IEPs I’ve been involved with have no less than 2-3 goals per target area resulting in anywhere from 7 to 15 goals. But wait! There are often 2-3 objectives as part of each goal area and each and every one requires some level of behavior change. To be fair, a goal to improve math skills may have sorting as an objective and it is routinely “met” without any knowledge on the part of the learner that s/he was able to do this task with 80% accuracy. Likewise, a written language goal for a 3rd grader may include generating paragraphs which might be easily tackled by just being an active learner in the classroom or resource room. But learning about social skills and the underlying thinking is a whole new ballgame. For many, social learning is something that doesn’t just happen by being exposed in a classroom to what he or she “should do.”
Before we can change behavior, help develop it, or expand it, we need to understand its origins.
What do we know about how kids learn information? There are literally thousands of research articles, books and websites dedicated to demystifying how children develop early skills. Social development starts before a child is born and continues to burst forth with new skills throughout the early years. Children as young as three days old are distinguishing between facial expressions, within the first they are starting to point to engage others in their thinking, and by the age of three are really quite brilliant in their use of social information. That is, if the child is developing in a “neurotypical” (NT) fashion. For those learners on the autism spectrum or who struggle with social learning, moving from recognizing facial expressions to pointing to understanding others’ intentions can be a lifelong learning process. This is an important point to consider given that our IEPs are written on a school year cycle and we routinely hope that a student will make several years worth of behavior shift over the course of one year. I don’t think I could do this…could you?
For example, think about an eight-year-old child who has no idea that his eyes can help him understand that teachers often look at the person to whom they are asking a question. Because of this, he routinely blurts out the answer to every question because he doesn’t use his eyes to gather this information. Would we really make a time sensitive (school year) goal to target talking to peers when this child should be working on using his eyes to understand the point of reference (joint attention)…something that babies are perfecting in the crib? But let’s say the goal is written on the child’s IEP. We’ve now asked this child to gain 6+ years of skills over the course of two semesters. What about the 9-year-old who can talk and talk and talk but never seems to be talking to anyone in particular? Why are we so persistent in having “maintaining a conversation” as the focus goal of his behavior change regime when the bigger issue is that he has no idea how to get his body into a group…a prerequisite to having a conversation?
We DO know that social learning forms the basis for so many important later developing skills. Recent advances in brain science confirm the complexity of the social brain, something most of us who have NT development simply take for granted. We know that the social brain is developing so rapidly that by four years of age, children are able to talk about understanding what other people are thinking. Kids this age are beginning to use something we call mental state words like “guess” and “know” and “think” in their everyday language. By the time a child is having his sixth birthday, he is learning how to lie and trick others; something we refer to as mental manipulation. We may not like to think of it, but understanding and using mental manipulation is one of life’s critical survival skills. If you don’t know when you are being tricked, you will likely wind up at the mercy of someone who is up to no good. Likewise, the spouse who doesn’t know when to say something tastes good when it may not is bound to find himself or herself in the proverbial doghouse.
The reality is that all of early social learning forms the basis not only for social participation and play but also for more abstract concepts such as problem solving, understanding people’s communicative intentions, written expression and reading comprehension. Not coincidentally, social knowledge and abstract social language and communicative interpretation are a distinct part of our academic curriculums. One of the great assumptions of students entering kindergarten is that they are equipped with an active social operating system; students are expected to understand they are part of a group and how to learn in a group (Winner, 2005). And, as our kids move through the school system a number of educational standards related to language arts tax a child’s ability to think socially. This means that students with social learning challenges aren’t simply struggling with “conversation” and “making friends” but are likely having issues understanding the motive and intentions of characters in fiction as well as others on the playground.
What else should I know about changing behavior?
With the advances in functional brain imaging we now know so much more about what happens when we are working on changing our own behaviors. Remember the January 1st goal to lose some weight? Our brains are pretty resistant when it comes to changing something we’ve done for awhile or something we find pleasurable. In fact, a professor from Stanford recently published a book on willpower and describes the brain as something that operates on the levels of “I will”, “I won’t”, and “I want” (McGonigal, 2012). If you think about behavior change in your own life, this makes a lot of sense. The “I want” part of our brains, or the midbrain, is actively seeking our desires while the front part of our brain tells us to “cool it” and stay on target. If you think about it this way you realize that your brain is having a bit of a spat with itself whenever you are working on changing your ways. An even more alarming statistic is that more than 40% of the things we do over the course of the day are rooted in habit, not thoughtful and deliberate decisions (Duhigg, 2012).
Wow. This adds a whole new spin on how we should be thinking about teaching behavior change, including social. We need to spend more time on getting our kids to have an awareness of what they are doing or not doing in order to kick their brains into the “I will” actions. This is one of the key tenets of Social Thinking (more on this later). And, like any new learning or behavior change it isn’t quick and it’s not based on the school year calendar. Social learning happens over the course of our lives and it changes based on our age and the context.
Okay. This child/student has social learning issues so who is responsible to help?
This is the moment where we imagine a circle of professionals pointing to one another with both hands crossed in a “he went that-a-way” sort of Laurel and Hardy spoof which happens right after pointing to the parents who are firing an index digit back at professionals. The truth is that there is no single profession trained to fully understand and develop treatment programs related to a child with social cognitive challenges. This is confusing to many school staff and parents. After all, isn’t this the job of speech-language pathologists (SLPs)? The simple answer to this is yes but no. The right answer is that SLPs should be involved along with every other person across the home and school day. While most SLPs have training in pragmatic language, few are highly trained in understanding the nuanced social and academic issues of the highly verbal ASD student (along with those who have ADHD, Nonverbal Learning disorder, emotional and mental health issues). Remember, social learning is the foundation for academic success! So, we all attend workshops to try to fill in the missing links between social learning, behavior, academics, and problem solving. The bottom line is that all of us must play a role in actively addressing these issues. It’s just too complex!
But it’s on the IEP!
One of the most powerful tools to guide instruction and intervention for children with learning issues of any sort is the Individualized Education Plan (IEP). It’s the roadmap for how and what we focus on for a particular individual. As professionals, we take a class or have a lecture about the process in college but nothing really prepares us for the mountain of paperwork that will ensue for each child. Parents also feel the cognitive fog that comes around each year when his or her child’s future is under a microscope. It’s actually mind-numbing for everyone involved, but a pivotal and crucial cog in the process.
I’ve found that many IEPs start on a positive note while discussing goals and objectives related to teaching how to add double digit numbers but may take a dramatic shift when the discussion changes to getting the child to “make friends.” Who will be in charge of that and what will the goal and objectives look like? As I look back on all of my coursework, I see nothing that prepared me, as an SLP, to select other children to form friendships for those on my caseload. I also know from years in the schools that putting kids into “friendship” groups didn’t equal friends. And yet, I understand the need for us as professionals (and the wishes of parents) to connect their children to others – after all we are all human and making connections with others is what we do (and also helps to keep the species around).
So, I tried for years to make the ever important social goals make sense based on my behavioral training. If I could just teach the child a rule for when and where to use his social skill, then he would be able to call upon that skill when needed. I taught many, many children with ASD how to greet by saying “hello” and I even taught many to shake hands in conjunction with the greet. When the IEP rolled around, I was proud to report that the child was 80-90% accurate in saying “hello” to others. Success, right? I thought so until I realized that my students were not only greeting and greeting and greeting, but they were shaking hands with new peers on the playground, walking away from the group and then greeting again and again. I taught the rule…”when you see someone in your class, say hello” and “when you meet someone new, shake his hand.” Oops.
I actually think that every professional and parent should try writing an IEP for his or her own behavior change. Write no more that two goal areas and no more than three objectives per goal area which results in only six things you need to change. Only six – this is fewer than what we typically ask of our students. Your brain will fight you and your habits will get in the way but you’ll have a better understanding of what we ask our children to do every year for about 12 years while in school. Several years ago I tried this and found that I performed at a 20-30% rate which falls in the UNMET category which means I will have the same objective for the next IEP - and the next -and the next.
With the realization that my skill-based approach seemed to be missing some depth, I went in search of something that would help me tackle the complex social issues of these children. I stumbled across the work of Michelle Garcia Winner and Social Thinking®. I remember my relief in finding a novel way to teach social skills. It wasn’t a cookbook of what to do, but instead helped me start to understand that I needed to shift away from simply teaching a social skill and instead begin to teach the thinking that underlies doing the social skill. For my high level kids with ASD, ADHD, and many others this provided the logic for why we do what we do socially. My IEPs began to change to reflect teaching WHY we use the social skills we do at the time and in the place that we use them. This made some sense to me. I like to know why I’m being asked to do something too.
What do you mean by Social Thinking?
Michelle Garcia Winner coined the term “Social Thinking” after spending several years with students who were considered to function “higher” on the autism spectrum; those with average to way above average language skills, but demonstrated significant social issues. Her clinical observations and knowledge of the research related to those with ASD (as well as others with social challenges) led her to develop the ILAUGH Model of Social Thinking (Winner, 2000). This model was (and is) a way to help professionals and parents more efficiently understand the core challenges associated with those with social issues. The ILAUGH model also helps link the relationship between social interaction, problem solving and the ability to interpret and respond to aspects of the academic curricula to create more efficient treatment programs while also respecting the complexity involved with teaching social learning to persons not intuitively born to these skills. (There are a number of books and articles related to this model which can be explored on the Social Thinking website, www.socialthinking.com ).
A very quick summary of the ILAUGH acronym is listed below:
I = Initiation of Language Initiation of communication and language is the ability to use one’s skills to seek assistance or information. A student’s ability to talk about his own interests can be in sharp contrast to how he communicates when he needs assistance. Many of our students do not ask for help or clarification. While a student may talk frequently in class about his own knowledge and ideas, he may not be proficient at using his sizable language skills to communicate effectively with others when he doesn’t know what to do next.
L= Listening with Eyes and Brain Most persons with social learning challenges have difficulty with auditory comprehension. However, listening requires more than just taking in the auditory information. It also requires the integration of information the student sees and hears to understand the deeper concept, or to make an educated guess about what is being said when the message cannot easily be literally interpreted. This can also be referred to as “active listening” or “whole body listening.” All teachers and parents realize that seeing leads to knowing; when they ask their students to listen they expect them to look. Through the Social Thinking approach we teach students to more actively “think with their eyes” in order to help them logically deduce the meaning of verbal and non-verbal cues.
A = Abstract and Inferential Language/Communication Communicative comprehension depends on one’s ability to recognize that most language or communication is not intended for literal interpretation. For example, a speaker might say “that was hot” but the listener can only interpret what this means by observing the speaker’s intentions within a context, which includes analyzing who the speaker is, who they are addressing and the context in which the message was spoken. The phrase would be interpreted differently if the speaker sees someone touching a metal chair sitting out in the sun verses the speaker observing a very interesting phenomenon.
U = Understanding Perspective As students evolve through the elementary and middle school years, great advances are made in the neurotypical child’s ability to interpret other people’s perspective at a level of increasing nuance and sophistication. Perspective taking is not black and white, and it continues to strengthen across our lifetimes. Those with a strong understanding and response to other people’s thoughts and minds across different contexts are those we celebrate as mature in our younger years and “wise” in our older years.
G = Gestalt Processing/Getting the Big Picture Information is conveyed through concepts, not just facts. For example, when having a conversation participants intuitively determine the underlying concept being discussed. When reading a book, the reader has to follow the overall meaning (concept) rather than just collect a series of details. When writing the student has to crystallize his or her ideas for others to follow and understand. Organizational skills for doing homework, written expression, cleaning our homes and work environments require us to “see the big picture” and assess what needs to be done before plugging in the details that will help us develop a systematized process to accomplish our goals.
H= Humor and Human Relatedness Many individuals with social challenges have a good sense of humor, but feel anxious since they miss the subtle cues which would help them understand how to participate more successfully with others in a social context. At the same time, many use humor inappropriately and candid lessons about when humor is funny versus inappropriate are often mandated by middle to later childhood. Emotional processing is also at the heart of human relatedness. Students with social learning challenges are developmentally weak at flexibly relating across a variety of people. While the majority of higher functioning persons on the autism spectrum have social motivation to establish and maintain relationships, their social mis-steps can serve as large barriers toward success. Social challenges directly impact our emotional processing which is central to our mental health.
Wow. Once I had a chance to digest this information I realized that social learning is REALLY complicated. No wonder people struggle to teach it and others struggle to learn it. I have to say that once I found this information it truly changed the way I thought about where my students might be having issues. I needed to shift gears and develop lessons around these areas of difficulty by using my students’ biggest area of strength - language. This is where the Social Thinking Vocabulary© came into play.
Break it down, break it down, break it down!
Many of our students are considered “bright” and even gifted when it comes to learning factual information, but struggle with the most basic social skills. Because our students often have strong cognitive skills, we tend to think that social learning should be as easy as other subjects. In fact, I’ve heard many say, “he’s so smart…why won’t he just do it?” Well, the fact remains that social learning is very difficult and must be broken down into smaller parts – much simpler than we might expect on most occasions. Social Thinking uses a core set of terms (Social Thinking Vocabulary©) that are friendly to both parents and professionals and provide a common language across home and school. There are many, many terms but for the purposes of this article, I’ve included a very general look at four.
Expected and Unexpected: We stray away from the terms “appropriate” and “inappropriate” because things really aren't that black and white. After all, yelling the name of another to get attention is probably unexpected in the library or classroom, but perfectly expected on the playground. So, instead we say that social behaviors are either expected or unexpected based on the context/situation and teach that these behaviors are linked to others’ thoughts and emotions.
Think with your eyes, ears and brain: We use our eyes to figure out what non-verbal messages others are sending as well as what they might be thinking about. Teaching this concept provides more information than just telling the student to “use good eye-contact” or “look at me.”
Whole body Listening: The idea is the whole body (eyes, ears, mouth, hands, feet, bottom and brain) needs to be focused on others in order to listen and to show you are listening.
People Files: People files are the way we organize information about people in our brains. When we meet someone we are supposed to remember some things about him/her so we can remember what that person may want to talk about the next time we meet. However, not all files are “friendly.” Sometimes we have to remember when someone is not safe to be around! Opening the files simply means that once you store the information you have to call it up when you see the person.
Now what? Where do I start?
This article isn't meant to say that we can’t change our ways but instead encourage all of us to think differently about behavior change. Not to simplify this process – because it’s truly a huge task. I've included five key ideas for each parent/professional/advocate/individual to consider when talking about helping our children increase, decrease, improve, eliminate, or just plain change something related to social learning.
1. Be thoughtful about how hard social learning is for many of our kids. It’s not like learning a math fact or memorizing a spelling word. For many, it means changing a behavior that may be very ingrained and that means it will take time. Sometimes it takes a very, very long time and doesn't always align with a school year.
2. Educate yourself about the new “CORE” academic standards to be a part of all 50 states and that will guide the direction of many of our IEPs in the upcoming years. These core standards are meant to provide some unity across states and are deeply, deeply connected to social learning. Things like working in groups, analyzing others’ perspectives, talking about topics on grade level are among the many that will be expected during the school day. The academic day is based in social learning and Social Thinking!
3. As a team, take the time to thoughtfully consider the actual number of “things” we are asking this child to learn or change over the next year and truly consider whether or not it is reasonable. You may want to also consider the use of rubrics (rather than percentages) to measure progress over the course of the quarter or semester. In other words, it’s very hard to measure whether or not a student asked for help 80% of the time (what does that mean anyway?) but it might be more accurate to use a 4-point rubric like the one listed below:
1 = student waits for a teacher or peer to approach and ask if he needs help. Student does not initiate a request for help when it is clear that he/she does not understand the task.
2 = student asks for help in highly motivating situations which may or may not be academic (e.g., may ask how to navigate through a computer game or help in selecting book).
3= student initiates a request for help on non-motivating or motivating activities through the use of a “strategy card” or other visual tool occasionally throughout the day.
4=student consistently initiates a request for help, clarification, or further information from peers or adults.
In this way, a parent and professional can have a clear picture of where the child is starting (beginning of year =level 1) and where he or she is during the next IEP update (level 2). The goal isn’t always to get to the highest point on the rubric in one year – it depends on the child. Remember…changing a behavior is hard. Some kids just need a strategy to improve while others may work for an entire year on shifting up one number on the rubric.
4. TALK! Professionals – we need to talk about how to make our goals and objectives realistic given the fact that our more verbal kids with social learning issues need to learn how to “think” about “why” they should do something that may not be intuitive. Parents, we need to talk about making goals/objectives realistic given the exact same reasoning above.
5. Most importantly, we all need to work on helping our kids learn this really challenging information across the home, school and community day in a humane and positive way without pointing and blaming one another. Wait….maybe we should put this on our own behavior change plans.
References
All information cited from Winner along with other core concepts and blogs/free articles about social learning and Social Thinking can be found at www.socialthinking.com
All information cited from Winner along with other core concepts and blogs/free articles about social learning and Social Thinking can be found at www.socialthinking.com
McGonigal, K. (2012). http://kellymcgonigal.com/willpowerinstinct/
Duhigg, C. (2012). http://charlesduhigg.com/
Dunn Buron, K. & Curtis, M. (2004). The Incredible 5-Point Scale. www.asperger.net
Gray, C. Social Stories: Multiple Publications on the topic. www.thegraycenter.org
BIO
Dr. Pamela Crooke is a speech-language pathologist and senior therapist at the Social Thinking Center in San Jose, CA. She has an active caseload of children, teens and adults with social learning challenges. The co-author of four books related to Social Thinking, Dr. Crooke consults/trains school programs locally and around the US, and presents on Social Thinking topics as part of the Social Thinking Training and Speakers Collaborative. She has served on the clinical faculty of three universities, worked as a school SLP for 15 years, and published a study on the effectiveness of using Social Thinking vocabulary in the schools. Learn more about her atwww.SocialThinking.com.
Dr. Pamela Crooke is a speech-language pathologist and senior therapist at the Social Thinking Center in San Jose, CA. She has an active caseload of children, teens and adults with social learning challenges. The co-author of four books related to Social Thinking, Dr. Crooke consults/trains school programs locally and around the US, and presents on Social Thinking topics as part of the Social Thinking Training and Speakers Collaborative. She has served on the clinical faculty of three universities, worked as a school SLP for 15 years, and published a study on the effectiveness of using Social Thinking vocabulary in the schools. Learn more about her atwww.SocialThinking.com.
Read more: http://www.autismsupportnetwork.com/news/autism-and-changing-your-ways-27892422#ixzz2g6RQMRL7
26 September 2013
Rote Memory
- Rote memory deals with words as opposed to ideas and relationships of mental concepts (logical memory). In other words, it is the ability to remember things without giving any thought to their meaning.
- It deals with symbols-figures-dates, which may be fixed in mind through the law of repetition without any effort of the intellect in the form of creative thinking.
- Consequently, the use of rote memory mat result in parrot-like repetition without any under-standing of the thought values represented by the words, figures or symbols which are being used
http://aspminds.com/rotememory.html
Example: A child may use the word "love" as in "I love you" because they have learned it by rote, without
grasping the underlying meaning of the concept. A strong aptitude for rote memory is a typical cognitive tendency among children with ASD. However, because they rote learn the alphabet and numbers, their approach to reading words and computation skills are above average and they typically are fluent readers. Unsuspecting teachers often do not realize that they do not understand what they read and assume that because they know that 3 - 1 = 2, they will know that if 3 birds are on a tree and 1 flies away, there will be 2 left. Difficulty dealing with abstract concepts is their hallmark.
- This capacity for strong rote memory is often accompanied by memory challenges in memory retrieval. A child might be able to name all the streets in his neighborhood yet be unable to answer to open ended questions such as: "where do you live?"
- A common misperception of autism is the tendency to link autism to special "savant" capabilities. Savant capabilities are extraordinary skills in a specific area, often combined with lower than average abilities in other areas of development. These savant capabilities are seen in only around 10% of the children who receive a diagnosis on the autism spectrum.
- Because many children with autism have an excellent rote and visual memory, teachers often think they understand something they have simply remembered. They use visual memory to compensate for their difficulty to understand. This leads to overdrilling because the child excels in the area of memorization. This is especially true of language and is heard when children recite scripts and speak in a robotic fashion.
- Be vigilant, change the order of the problems or vocabulary words on the page, for instance, and make sure that the child understands and is not just memorizes when teaching.
- The child may need guidance when selecting which bits of information to attend to and retain, but should also be encouraged to hone his or her skill of memorizing key facts, figures and other essential information. This kind of rote learning is valuable for educational activities such as phonics (learning the sounds of the alphabet and other letter strings), learning to count and memorizing multiplication and division facts.
- Rote memory is related to strong visual perception, and many children with ASD learn numbers and letters before they can talk. Use their knowledge as a motivator in activities to strengthen other skills such as fine and gross motor skills (ie. using a number puzzle as part of an obstacle course, using dot markers to fill in the first letter of their name, etc.)
- Find ways to help the child really grasp the concept of what they are doing, by helping the to actually "see" the problem, such as writing it down on paper, drawing it out, or physically demonstrating it.
Aspergers Tantrums, Rage, and Meltdowns
Aspergers Tantrums, Rage, and Meltdowns
My eldest boy J___ who is now 5-years-old was diagnosed with Aspergers last July. We did 6 months of intense therapy with a child psychologist and a speech therapist before we moved over to Ghana. J___ has settled in well. He has adjusted to school very well and the teachers who are also expats from England are also dealing with him extremely well.
My current issue is his anger. At the moment if the situations are not done exactly his way he has a meltdown. Symptoms are: Extreme ear piercing screaming, intense crying, to falling down on the floor saying he is going to die. I have tried to tell him to breathe but his meltdown is so intense that his body just can't listen to words. I then have asked him to go to his room to calm down. He sometimes (very rarely) throws things across the room, but does not physically hurt anyone. As I have two younger boys (ages 1 and 3) I still need to be aware of their safety. I then managed to put J___ in his room with the help of a nanny. He throws all blankets off the bed (which doesn't bother me) and then hides under them. Today I waited 10 minutes then went upstairs to talk to him, but he then started again with the extreme crying and screaming at me. It took him over an hour to calm down fully. The situation arose as the nanny and I were helping him to make muffins and the nanny put a spoonful of the mixture into the muffin tin.
I am requesting your help on ways to calm him down in a manner that is acceptable. He is getting too old to be put in the "thinking corner/naughty corner" and I am a petite person so I'm not going to physically put him there. I am finding his resistance at the moment is a lot with me and his father.
I have structures in place by visual laminated pictures of how the morning is run and the structure before bed. This works fine, but like I said when things aren't done exactly his way, he can have an outburst in a flash. Please give me some strategies on how I can better manage these meltdowns.
FYI - he was diagnosed on the border on the CARS model. I have found a qualified speech therapist who is from England which we go to once a week (but as it is summer break we don't go back to August) to assist with his pragmatic language.
Answer
Problems related to stress and anxiety are common in kids with Aspergers. In fact, this combination has been shown to be one of the most frequently observed comorbid symptoms in these chidlren. They are often triggered by or result directly from environmental stressors, such as:
• a sense of loss of control
• an inherent emotional vulnerability
• difficulty in predicting outcomes
• having to face challenging social situations with inadequate social awareness
• misperception of social events
• rigidity in moral judgment that results from a concrete sense of social justice violations.
• social problem-solving skills
• social understanding
The stress experienced by kids with ASPERGERS may manifest as withdrawal, reliance on obsessions related to circumscribed interests or unhelpful rumination of thoughts, inattention, and hyperactivity, although it may also trigger aggressive or oppositional defiant behavior, often captured by therapists as tantrums, rage, and “meltdowns”.
Educators, therapists, and moms/dads often report that kids with ASPERGERS exhibit a sudden onset of aggressive or oppositional behavior. This escalating sequence is similar to what has been described in kids with ASPERGERS, and seems to follow a three-stage cycle as described below. Although non-ASPERGERS kids may recognize and react to the potential for behavioral outbursts early in the cycle, many kids and teenagers with ASPERGERS often endure the entire cycle, unaware that they are under stress (i.e., kids with ASPERGERS do not perceive themselves as having problems of conduct, aggression, hyperactivity, withdrawal, etc.).
Because of the combination of innate stress and anxiety and the difficulty of kids with ASPERGERS to understand how they feel, it is important that those who work and live with them understand the cycle of tantrums, rage, and meltdowns, and the interventions that can be used to promote self-calming, self-management, and self-awareness as a means of preventing or decreasing the severity of behavior problems.
The Cycle of Meltdowns
Meltdowns typically occur in three stages that can be of variable length. These stages are (1) the “acting-in” stage, (2) the “acting-out” stage, and (3) the recuperation stage.
The “Acting-In” Stage
The “acting-in” stage is the initial stage of a tantrum, rage, or meltdown. During this stage, kids and teenagers with ASPERGERS exhibit specific behavior changes that may not seem to be related directly to a meltdown. The behaviors may seem minor. That is, kids with ASPERGERS may clear their throats, lower their voices, tense their muscles, tap their foot, grimace, or otherwise indicate general discontent. Furthermore, somatic complaints also may occur during the “acting-in” stage. Kids also may engage in behaviors that are more obvious, including emotionally or physically withdrawing, or verbally or physically affecting someone else. For example, the youngster may challenge the classroom structure or authority by attempting to engage in a power struggle.
During this stage, it is imperative that a mother/father or educator intervene without becoming part of a struggle. The following interventions can be effective in stopping the cycle of tantrums, rage, and meltdowns – and they are invaluable in that they can help the youngster regain control with minimal adult support:
1. Intervention #1 involves displaying a chart or visual schedule of expectations and events, which can provide security to kids and teenagers with ASPERGERS who typically need predictability. This technique also can be used as advance preparation for a change in routine. Informing kids of schedule changes can prevent anxiety and reduce the likelihood of tantrums, rage, and meltdowns (e.g., the youngster who is signaling frustration by tapping his foot may be directed to his schedule to make him aware that after he completes two more problems he gets to work on a topic of special interest with a peer). While running errands, moms and dads can use support from routine by alerting the youngster in the “acting-in” stage that their next stop will be at a store the youngster enjoys.
2. Intervention #2 involves helping the youngster to focus on something other than the task or activity that seems to be upsetting. One type of redirection that often works well when the source of the behavior is a lack of understanding is telling the youngster that he can “cartoon” the situation to figure out what to do. Sometimes cartooning can be postponed briefly. At other times, the youngster may need to cartoon immediately.
3. Intervention #3 involves making the Aspergers child’s school environment as stress-free as possible by providing him/her with a “home-base.”. A home-base is a place in the school where the child can “escape.” The home-base should be quiet with few visual or activity distractions, and activities should be selected carefully to ensure that they are calming rather than alerting. In school, resource rooms or counselors' offices can serve as a home-base. The structure of the room supersedes its location. At home, the home-base may be the youngster's room or an isolated area in the house. Regardless of its location, however, it is essential that the home-base is viewed as a positive environment. Home-base is not “timeout” or an escape from classroom tasks or chores. The youngster takes class work to home-base, and at home, chores are completed after a brief respite in the home-base. Home-base may be used at times other than during the “acting-in” stage (e.g., at the beginning of the day, a home base can serve to preview the day's schedule, introduce changes in the typical routine, and ensure that the youngster's materials are organized or prime for specific subjects). At other times, home-base can be used to help the youngster gain control after a meltdown.
4. Intervention #4 involves paying attention to cues from the Aspergers child. When the youngster with ASPERGERS begins to exhibit a precursor behavior (e.g., throat clearing, pacing), the educator uses a nonverbal signal to let the youngster know that she is aware of the situation (e.g., the educator can place herself in a position where eye contact with the youngster can be achieved, or an agreed-upon “secret” signal, such as tapping on a desk, may be used to alert the youngster that he is under stress). A “signal” may be followed by a stress relief strategy (e.g., squeezing a stress ball). In the home or community, moms and dads may develop a signal (i.e., a slight hand movement) that the mother/father uses with their youngster is in the “acting-in” stage.
5. Intervention #5 involves removing a youngster, in a non-punitive fashion, from the environment in which he is experiencing difficulty. At school, the youngster may be sent on an errand. At home, the youngster may be asked to retrieve an object for a mother/father. During this time the youngster has an opportunity to regain a sense of calm. When he returns, the problem has typically diminished in magnitude and the grown-up is on hand for support, if needed.
6. Intervention #6 is a strategy where the educator moves near the youngster who is engaged in the target behavior. Moms/dads and teachers move near the Aspergers youngster. Often something as simple as standing next to the youngster is calming. This can easily be accomplished without interrupting an ongoing activity (e.g., the educator who circulates through the classroom during a lesson).
7. Intervention #7 is a technique in which the mother/father or educator merely walks with the youngster without talking. Silence on the part of the grown-up is important, because a youngster with ASPERGERS in the “acting-in” stage will likely react emotionally to any adult statement, misinterpreting it or rephrasing it beyond recognition. On this walk the youngster can say whatever he wishes without fear of discipline or reprimand. In the meantime, the grown-up should be calm, show as little reaction as possible, and never be confrontational.
8. Intervention #8 is a technique that is effective when the youngster is in the midst of the “acting-in” stage because of a difficult task, and the mother/father or educator thinks that the youngster can complete the activity with support. The mother/father or educator offers a brief acknowledgement that supports the verbalizations of the youngster and helps him complete his task. For instance, when working on a math problem the youngster begins to say, “This is too hard.” Knowing the youngster can complete the problem, the educator refocuses the youngster's attention by saying, “Yes, the problem is difficult. Let's start with number one.” This brief direction and support may prevent the youngster from moving past the “acting-in” stage.
When selecting an intervention during the “acting-in” stage, it is important to know the youngster, as the wrong technique can escalate rather than deescalate a behavior problem. Further, although interventions at this stage do not require extensive time, it is advisable that grown-ups understand the events that precipitate the target behaviors so that they can (1) be ready to intervene early, or (2) teach kids and teenagers strategies to maintain behavior control during these times. Interventions at this stage are merely calming. They do not teach kids to recognize their own frustration or provide a means of handling it. Techniques to accomplish these goals are discussed later.
The “Acting-Out” Stage
If behavior is not diffused during the “acting-in” stage, the youngster or adolescent may move to the “acting-out” stage. At this point, the youngster is dis-inhibited and acts impulsively, emotionally, and sometimes explosively. These behaviors may be externalized (i.e., screaming, biting, hitting, kicking, destroying property, or self-injury) or internalized (i.e., withdrawal). Meltdowns are not purposeful, and once the “acting-out” stage begins, most often it must run its course.
During this stage, emphasis should be placed on youngster, peer, and adult safety, and protection of school, home, or personal property. The best way to cope with a tantrum, rage, or meltdown is to get the youngster to home base. As mentioned, this room is not viewed as a reward or disciplinary room, but is seen as a place where the youngster can regain self-control.
Of importance here is helping the individual with ASPERGERS regain control and preserve dignity. To that end, grown-ups should have developed plans for (1) obtaining assistance from educators, such as a crisis educator or principal, (2) removing other kids from the area, or (3) providing therapeutic restraint, if necessary.
The Recuperation Stage
Following a meltdown, the youngster with ASPERGERS has contrite feelings and often cannot fully remember what occurred during the “acting-out” stage. Some may become sullen, withdraw, or deny that inappropriate behavior occurred; others are so physically exhausted that they need to sleep.
It is imperative that interventions are implemented at a time when the youngster can accept them and in a manner the youngster can understand and accept. Otherwise, the intervention may simply resume the cycle in a more accelerated pattern, leading more quickly to the “acting-out” stage. During the recuperation stage, kids often are not ready to learn. Thus, it is important that grown-ups work with them to help them once again become a part of the routine. This is often best accomplished by directing the youth to a highly motivating task that can be easily accomplished, such as activity related to a special interest.
Preventing Tantrums, Rage, and Meltdowns
Kids and teenagers with ASPERGERS generally do not want to engage in meltdowns. Rather, the “acting-out” cycle is the only way they know of expressing stress, coping with problems, and a host of other emotions to which they see no other solution. Most want to learn methods to manage their behavior, including calming themselves in the face of problems and increasing self-awareness of their emotions. The best intervention for tantrums, rage, and meltdowns is prevention. Prevention occurs best as a multifaceted approach consisting of instruction in (1) strategies that increase social understanding and problem solving, (2) techniques that facilitate self-understanding, and (3) methods of self-calming.
Increasing Social Understanding and Problem Solving
Enhancement of social understanding includes providing direct assistance. Although instructional strategies are beneficial, it is almost impossible to teach all the social skills that are needed in day-to-day life. Instead, these skills often are taught in an interpretive manner after the youngster has engaged in an unsuccessful or otherwise problematic encounter. Interpretation skills are used in recognition that, no matter how well developed the skills of a person with ASPERGERS, situations will arise that he or she does not understand. As a result, someone in the person's environment must serve as a social management interpreter.
The following interpretative strategies can help turn seemingly random actions into meaningful interactions for kids with ASPERGERS:
1. Analyzing a social skills problem is a good interpretative strategy. Following a social error, the youngster who committed the error works with an adult to (1) identify the error, (2) determine who was harmed by the error, (3) decide how to correct the error, and (4) develop a plan to prevent the error from occurring again. A social skills analysis is not “punishment.” Rather, it is a supportive and constructive problem-solving strategy. The analyzing process is particularly effective in enabling the youngster to see the cause/effect relationship between her social behavior and the reactions of others in her environment. The success of the strategy lies in its structure of practice, immediate feedback, and positive reinforcement. Every grown-up with whom the youngster with ASPERGERS has regular contact, such as moms and dads, educators, and therapists, should know how to do social skills analysis fostering skill acquisition and generalization. Originally designed to be verbally based, the strategy has been modified to include a visual format to enhance child learning.
2. Visual symbols such as “cartooning” have been found to enhance the processing abilities of persons in the autism spectrum, to enhance their understanding of the environment, and to reduce tantrums, rage, and meltdowns. One type of visual support is cartooning. Used as a generic term, this technique has been implemented by speech and language pathologists for many years to enhance understanding in their clients. Cartoon figures play an integral role in several intervention techniques: pragmaticism, mind-reading, and comic strip conversations. Cartooning techniques, such as comic strip conversations, allow the youngster to analyze and understand the range of messages and meanings that are a natural part of conversation and play. Many kids with Aspergers are confused and upset by teasing or sarcasm. The speech and thought bubble as well as choice of colors can illustrate the hidden messages.
Conclusion—
Although many kids and teenagers with ASPERGERS exhibit anxiety that may lead to challenging behaviors, stress and subsequent behaviors should be viewed as an integral part of the disorder. As such, it is important to understand the cycle of behaviors to prevent seemingly minor events from escalating. Although understanding the cycle of tantrums, rage, and meltdowns is important, behavior changes will not occur unless the function of the behavior is understood and the youngster is provided instruction and support in using (1) strategies that increase social understanding and problem solving, (2) techniques that facilitate self-understanding, and (3) methods of self-calming.
Kids with ASPERGERS experiencing stress may react by having a tantrum, rage, or meltdown. Behaviors do not occur in isolation or randomly; they are associated most often with a reason or cause. The youngster who engages in an inappropriate behavior is attempting to communicate. Before selecting an intervention to be used during the “acting-out” cycle or to prevent the cycle from occurring, it is important to understand the function or role the target behavior plays.
Asperger’s and High-Functioning Autism: Fact Sheet for Teachers
Asperger’s and High-Functioning Autism: Fact Sheet for Teachers
To all parents of children with Asperger’s (AS) and High Functioning Autism (HFA):Below is a fact sheet that you can email (or hand-deliver a hard copy) to your child’s teacher(s). This fact sheet provides a short description of AS and HFA – and associated behaviors. Since all kids on the autism spectrum are different, parents should only use those items that directly apply to their youngster, making changes and additions as necessary. Copy and paste sections of the fact sheet – whatever you need to do to make it fit your child’s particular situation. It’s recommended that you only pick a few relevant items from the appropriate categories, rather than bombarding your child’s teacher(s) with the entire list.
Fact sheet for teachers with students on the autism spectrum:
Hello, I am _____'s parent. My youngster has been diagnosed with Asperger's (AS) – also called High Functioning Autism (HFA) – which is a neurobiological disorder on the autistic spectrum. Kids with AS and HFA often have difficulty using and understanding nonverbal cues and developing appropriate peer relationships. While they often have special interests and skills in certain areas, they also have difficulty with organization. AS and HFA kids often appear to lack empathy, havedifficulty with sensory issues, and strongly rely on routine.
My youngster has many strengths. However, listed below are some issues that may become apparent to you as you work with him/her. Many of the behaviors you will see are not under his/her control, and they are not a result of malice or willful misbehavior. At times, my youngster simply does not innately know how to respond appropriately. I’m sure you will learn other techniques that will be helpful, and I would appreciate your sharing those with me. Please call me at any time if you have questions. I can be reached at: __________
General Behaviors:
- AS/HFA is characterized by a sort of "Swiss cheese" type of development (i.e., some things are learned age-appropriately, while other things may lag behind or be absent). In addition, these kids may have skills years ahead of normal development (e.g., the youngster may understand complex mathematics principles, but not be able to remember to bring their homework home).
- At times, my youngster may experience “meltdowns.” At times like this, please allow a "safe and quiet location" where he/she will be allowed to "cool off." Try to take note of what occurred before the meltdown (e.g., an unexpected change in routine). Also, it's best to talk with him/her "after" the situation has calmed down. Notify me of any meltdowns.
- Please foster a classroom atmosphere that supports the acceptance of differences and diversity.
- Please remember that just because my youngster learns something in one situation, this doesn't automatically mean that he/she remembers or is able to generalize the learning to new situations.
- Please note my child’s strengths often and visually. This will give him/her the courage to keep moving forward.
- My youngster may have vocal outbursts. Be prepared for them, especially when he/she is having a difficult time. Also, please let the other kids know that this is his/her way of dealing with stress or fear.
- My youngster may need help with problem-solving situations. Please be willing to take the time to help with this.
- My youngster reacts well to positive and patient styles of teaching.
- When dividing-up assignments, please assign teams rather than have the other kids "choose” members, because this increases the chances that my youngster will be left out or teased.
- When it reaches a point that things in the classroom are going well, it means that we've gotten it right. It doesn't mean that my youngster is “cured” …never had a problem to begin with …or that it's time to remove support. Increase demands gradually.
- When you see anger or other outbursts, my youngster is not being deliberately difficult. Instead, this is a "fight or flight" response. Think of this as an "electrical circuit overload." Prevention can sometimes head-off these situations if you see the warning signs coming.
Perseverations:
- My youngster may repeat the same thing over and over again, and you may find this increases as stress increases. Please try to avoid answering the same thing over and over or raising your voice or pointing out that the question is being repeated. Instead, try to redirect my youngster's attention or find an alternative way so he/she can save face. Allowing my youngster to write down the question or thought, and providing a response in writing, may be very helpful at times.
Transitions:
- Giving one or two warnings before a change of activity or schedule may be helpful.
- My youngster may have a great deal of difficulty with transitions. Having a picture or word schedule may be useful.
- Please try to give as much advance notice as possible if there is going to be a change or disruption in the schedule.
Sensory Motor Skills/Auditory Processing:
- Breaking directions down into simple steps can be quite helpful.
- Directions are more easily understood if they are repeated clearly, simply, and in a variety of ways.
- My youngster has difficulty understanding a string of directions or too many words at one time.
- My youngster may act in a very clumsy way sometimes.
- He/she may react very strongly to certain tastes, textures, smells and sounds.
- Speaking slower and in smaller phrases can help.
- Using picture cures or directions may also help.
Stimuli:
- Please consider allowing my child to "move about" occasionally since sitting still for long periods of time can be very difficult for him/her. Even a 3-minute walk down the hallway and back (with a friend or aide) can help a lot.
- My child may get over-stimulated by loud noises, lights, strong tastes or textures, because of the heightened sensitivity to these things.
- Unstructured times (e.g., lunch, break, PE) may prove to be the most difficult for my child. Please try to help provide some guidance during these more difficult times.
- With lots of other children around, chaos and noise, it would be helpful if you would try to help my child find a quiet refuge to which he/she can go for a time-out.
Visual Cues:
- Hand signals may be useful, especially to reinforce certain messages (e.g., "wait your turn" … “stop talking out of turn” … "speak more slowly or softly").
- Most AS and HFA kids learn best with visual aids (e.g., picture schedules, written directions or drawings).
Interruptions:
- When someone tries to help by finishing my child’s sentences or interrupting, he/she often has to go back and start over to get the train of thought back.
- At times, it may take more than few seconds for my youngster to respond to questions. My youngster needs to stop what he's/she’s thinking, put that somewhere, formulate an answer, and then respond. Please wait patiently for the answer, and encourage others to do the same. Otherwise, he/she will have to start over again.
Eye Contact:
- Unlike most of us, forcing eye contact may break my child’s concentration.
- He/she may actually hear and understand you better if not forced to look directly at your eyes.
- At times, it looks as if my youngster is not listening to you when he/she really is. Don't assume that, because my youngster is not looking at you, that he/she is not hearing you.
Social Skills and Friendships:
- Children with AS and HFA are often at greater risk for becoming victims of bullying by peers. This is influenced by a couple of factors: (1) AS and HFA children want to be included and/or liked so badly that they are reluctant to "tell" on the bully, fearing rejection from the perpetrator or other children; (2) there is a great likelihood that the response that the bully gets from the AS or HFA youngster reinforces this kind of behavior.
- Young people with AS and HFA often want to make friends, but don’t have a clue as to how to go about it.
- Identifying 1 or 2 empathetic children who can serve as "helpers" will help my youngster feel as though the world is a friendlier place.
- Talking with the other students in the class about AS and HFA may help – if done in a positive way (e.g., talking about the fact that many of us have challenges, and that the AS/HFA youngster’s challenge is that he/she can’t read social situations very well, just as others may need glasses or hearing aids).
Routine:
- Please let my child know, if possible, when there will be a substitute teacher or a field trip occurring during regular school hours.
- Please let my youngster know of any anticipated changes as soon as you know about them, using picture or word schedules.
Language:
- Sarcasm and humor are often not understood by my youngster. Even explanations of what is meant may not clarify, because the perspectives of AS and HFA kids can be unique and, at times, immovable.
- Although my child’s vocabulary and use of language may seem high, he/she may not know the meaning of what he/she is saying, even though the words sound correct.
Organizational Skills:
- If necessary, please allow my child to copy the notes of other peers. Many AS and HFA kids have difficulty multi-tasking (e.g., listening to the teacher while reading the board and taking notes).
- It may be helpful to develop schedules (picture or written) for my child.
- My youngster lacks the ability of remember a lot of information – and how to retrieve that information for its use.
- Please post schedules and homework assignments on the board and make a copy for my child.
- Please make sure that assignments get put into my child’s backpack, because he/she can't always be counted on to get everything home without some help.
Note: At times, some of my youngster's behaviors may irritate his/her peers – and you! Please know that this is normal and expected. Try not to let the difficult days color the fact that you are a wonderful teacher with a challenging situation. Nothing works all of the time, and some things may not work at all. Always feel free to share with me whatever you would like. I have heard it all before. It will not shock me or make me think less of you. Communication is the key, and by working together as a team, we can provide the best for my youngster.
Thank you very much,
_______________ (parent’s name)
P.S. For more information on teaching students with AS and HFA, please go to www.MyAspergersChild.com and get your copy of"Teaching Students with Aspergers and HFA". You can print as many copies as you like and share this valuable information with the other teachers, school counselors, etc.
MY CHILD HAS BEEN REJECTED BY HIS PEERS, RIDICULED AND BULLIED !!!
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