I did it by myself!

The sentence above holds a deep meaning, one of therapeutic value. It requires precision and skill to perform tasks as mundane as brushing, eating or dressing and often-times, in conditions as challenging as Autism, this is a persistent obstacle.

One may render greater value to the common difficulties faced by kids with autism such as in communication, behaviour and socializing, than the ones faced while performing basic activities of daily living (BADL). However, it is also crucial to address self-help skills.

What are self-help skills?

Self-help skills commonly include those skills that enable one to perform their BADL such as eating, maintaining personal hygiene, toileting, dressing, grooming and a few others.

Why is it important to address self-help skills in children with Autism?

Making a child perform or help to perform self-help skills boosts their self-esteem. It is but a well-known fact that a higher self-esteem motivates an individual to perform better including children.

How to train them?

At the initial stages, parents can ask their therapist to identify and explain the individual difficulties encountered by the child.

Children with autism can be grouped into two:

  • With some gross and fine motor skills needed to perform a self-help activity for e.g. shoulder stability and finger control for brushing, &
  • Without these basic skills

Now the parent can focus on developing the basic skills in the latter group using Sensory integration and other therapeutic modalities taught by their therapist, whereas the former group can actually begin participating in the process.

Chaining is the most commonly employed therapeutic tool to make a child with autism understand and develop concept about a particular activity. Just as one gets the child to participate in a therapy session by linking activities to each other, the child can be taught to perform each step of a given self-help activity in a forward or backward chain. For e.g. Toileting requires walking upto and opening the toilet door, entering and unbuttoning the trousers, pulling them down and sitting. Initially the caregiver can be trained to perform two steps for the child, and teach the child the next two steps. Gradually, all steps can be linked together and with practice, a skill can be developed.

Visual cues and prompts may be included. Colorful printouts with photographical representation of each step can be an example of a visual cue. Social stories may also be used as the stories contain relatable scenarios.

To conclude, children with autism as they grow, may turn into individuals with limited engagement in daily activities. Parents may then find it laborious to perform each daily living activity for their child. Thus, an early emphasis must be placed on training children with autism to engage in self-help techniques.

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Name : Dr.Jayanti Sundar Rajan

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This section aims at trying to help & guide Children with Autism.

It looks at problems faced while socializing in a group, initiating talks and suggesting ways by which a person with Autism Spectrum Disorder (ASD) can meet and develop positive & understandable relations with others.

One has to face varied social situations which often are very difficult for people with Autism. There are so many social rules one has to follow while meeting, chatting, eating, talking and behaving. A person without Autism learns things easily, instinctively.

But for a person in the spectrum, it becomes so confusing at times to understand social rules that are unwritten and unspoken.

This section would try to fit in most of the ideas which can offer, if not all, then some surficial suggestions to help the children while socializing or initiating a conversation.

Understanding Social Skills:

1. Social skills are standard ways of interaction

2. They are certain behaviour patterns that predict social outcomes viz. delight, consent, appreciation, etc.

3. Social skills are a medium of cognitive and verbal communication skills.

Generally social skill sets are picked up naturally and easily but people with Autism usually don’t have an implicit social mapping. For this, they need consistent Training and Practice.

To help the children facing social expectation challenges, we need to make implicit rules …Explicit. These rules need to be explicitly explained, practiced & reinforced.

Below are simple ways to start with:

While talking to Elders:

Try using a requesting language as well as respecting ways while addressing elder relatives.viz, using niceties like ‘please’ & ‘thank you’.

Most families prefer their elders to be called by relation and not by names, as Grandfather, Grandma, Aunt & Uncle appropriately. If you have made a mistake and upset your elders and don’t know how to behave in this kind of situation. Saying ‘sorry’ will help.

While talking with Peers:

(Academic Peers/ Play Peers) - If you want to initiate talk with someone of the same age group, or ability, It’s better to use “Hello” first as a greeting or “Excuse me”to grab attention. Greetings should be used appropriate to a situation. And try using Peer network strategy, which says if the person whom you greeted replies you with “ Hello” or greets you back, it usually means they are willing to talk. It’s good if you ask a couple of general questions / statements, viz. How are you doing? ; You are looking nice; you played well.

Penning down certain general questions is a good idea before you like to initiate talking. Making friends: It becomes very difficult for children with autism to make new friends. But once we understand them they can be the most precious and innocent hearted friends. One always needs a friend to talk & discuss things, to hang around and to rely on confidently.

This becomes very difficult for people with ASD to gauge the intrinsic feeling of someone, whether they are real friends or pretending friends because they either use voice & speech tones or body language for expression. People with ASD find it very difficult to detect and notice these expressions.

For that, try to wait for true friends, they will treat you in the same manner as they treat all their other friends. They will try to reach you and talk to you whenever they find time, they will share things and talks as well as care for you. This way you can easily differentiate and say content.

While talking to Age-Juniors:

Try to be as helpful and caring to juniors as your parents and teachers are to you. Try to make them feel welcome and talk gently to kids younger to you. Always give them a tender touch or a hug of affection.

Turn taking skills:

Kids with Autism find conversational skills tricky for numerous reasons. Conversations are not predictable and take on an instant response. This is the reason why kids with Autism avoid talking to peers and will often prefer talking to adults or kids much older or younger to them.

Talking about their particular interest: Most of the Kids with ASD have a special field of interest, they like to talk about or demonstrate it to others but they may need to learn that what interests them might not be of interest to others. It can be a good idea to form list of different topics, viz. Your favourite animal, greatest holiday, the weather today, your favourite singer, a movie, something you want to buy, a cartoon character etc. Instruct the child to pick one out and begin a conversation based on that topic so he learns to talk about different topics outside their immediate sphere of interest. Strike that one out when over and done with and move on with something new in his next attempt.

Board games are very useful to teach turn taking to kids with ASD. As these are tangible, visual and patterns can be easily grasped such as dice, strikers, etc. Turn taking embraces a set of skills used at once, but the main skill involved here is the need to be aware of others’ presence. And in such a set up of turn taking we need to follow the rules and take the feelings of others’ playing together in consideration to stay in the game.

Appropriate re-channelling of Emotions based on situations:

This sub section includes the idea of knowing oneself and one’s emotions first. And then analyzing the situation accordingly that may also involve proficient reading of the signals of others as a part of that situation viz. body language, facial expressions, voice intonation, contextual cues etc.

This probably is very challenging for kids in the spectrum. To manage such a situation ‘Practice’ is the only solution. Having a practiced set of verbal skills - vocabulary/intonation; action skills- eye contact, smile, hand extension, etc., will help to a larger extent.

Seven Steps Model for learning Social Skills:

Step1-Setting a Goal: select and noticeably define a handy & useful social skills goal.

Step2-Edify: illustrate what behaviour & conduct looks like and why this behaviour is important.

Step3-Model representation: display & make obvious the desired social behaviour.

Step4-Practice: The desired behaviour should be practiced over & over again with the help of role plays.

Step5-Timely & appropriate way of using of social skill : Initially one can start with a more explicit way of expression viz complimenting someone using encouraging adjectives, later on this should slowly fade and compliments should come rather naturally and even just a gesture for that matter. Try for a much natural display of desired behaviour.

Step6-Reinforcing & encouraging liberally: when someone has performed goal behaviour, we should reinforce it. Reinforcements may be little (just a hug, high five, etc.) but they should be of value to the performing child & the child should know what for he is getting reinforced.

Step7-Generalizing the process: promoting the practice of the behaviour at home, among peers, community and society in general and don’t miss to reinforce copiously for performing desired social skill goal behaviour.

How can one  develop speech and language in non-verbal children or teenagers with autism. This is one of the major concerns of those related with such category.  Researchers  have found out effective strategies to improve this issue. The main thing to remember is that we should consider each person with autism as unique and strategies should be implemented accordingly. Each child is differently abled. A strategy that worked effectively for one might not work as effective for another child or teenager with autism.

As we all know non-verbal communication accounts more than verbal communication  similarly in case of autistic children non-verbal communication with the help of visual supports and assistive technologies makes it easier for them.

The seven strategies for promoting language development in non-verbal children and adolescents with autism are:-

  1. Focus on non-verbal communication. The use of body languages along with voice makes it easier for the autistic children to understand. Gestures and eye contact can build a foundation for language. The usage of gestures should be in a way that the child can easily imitate and relate to it. For example nodding of head, point out a particular items, etc.

  2. Simplify your language. Using simple language while interacting makes it easier for the child to imitate your speech. In case of the child being non-verbal use single words while communicating. If your child speaks single words, try speaking in short phrases or more than what the child speaks.

  3. Allow your child to talk by giving ample response time. It's human tendency to fill in language when a child doesn't respond spontaneously. But always give your child lots of opportunities to respond, even if the child isn't talking. When you ask a question see that it is answered by the child verbally or non-verbally.

  4. Structure the communication according to the child's interest: While communicating with your child make it a point to associate vocabulary with the child's area of interest such as narrating what the child is doing, naming the things used by the child for playing so that the child not be restless. By talking about what engages your child will help him learn vocabulary easier..

  5. Imitate your child.Reproducing your child's sound, behaviours and action motivates for more vocalizing and interactions. As the child gets a reflection of his own actions it helps in taking turns if its feels odd. Always remember while duplicating your child only positive behaviour should be imitated.

  6. Encourage social interaction. The easiest way for a child to learn a language is through interactive play and social interaction. This gives opportunities for the child to develop his communication. Playing variety of games according to the interest, focusing on the different ability of the child like singing, reciting rhymes and by promoting interaction with family members and society develops the language.

  7. Use of assistive devices and visual supports. Training the child with the use of assistive technologies and visual supports fosters the speech and language development. Now a days there are mains apps and devices which helps for this purpose which can do more than take the place of speech.

All individuals with autism are unique and so are their reasons for toileting problems. While a typically developing child usually learns to regulate this basic function, an individual with autism may find it harder to get in sync.

  • Often, a very common reason for toileting problems is difficulty in processing sensory messages. An individual may be under responsive to sensation and lack the body awareness to know that they need to eliminate. They may not notice their pants are wet and soiled or that they smell bad.
  • An individual may be over responsive to sensation. They may not be comfortable with the noise made by flushing the toilet or the feel of the toilet seat or they may have gravitational insecurity and are not comfortable on the toilet seat with their feet off the ground.
  • An individual may be a sensory seeker and may find it comfortable to sit on warm squishy fecal matter or to play with it. This kind of stimulation may not be socially acceptable.
  • An individual may have difficulty in discriminating between ‘empty’ and ‘almost empty’ and may jump off the toilet before completing a bowel movement.
  • An individual may have difficulty in getting into and maintaining a stable position.
  • An individual may have dyspraxia, which makes it difficult for them to come up with the idea of unbuttoning and unzipping their pants, motor plan these tasks, and how to carry out these plans.
  • Wetting and soiling clothing results in significant amount of time, energy and resources being spent on an individual’s personal care needs. Soiled clothing and poor toilet hygiene also significantly interferes with social acceptance. Some behaviors of these individuals may also prove a health risk to the individual.
  • Though it is generally believed that autistic individuals are the most difficult to toilet train, different strategies and techniques can be used to make this task effective. To achieve success in this task, it is essential that the needs and characteristics unique to an individual be considered while planning intervention. Following are some of the pointers which may help ease this difficult task of toilet training an autistic individual:
  • For typical days, document the autistic individual’s routine. Track how long it takes between when the individuals eats or drinks and when he or she is wet. Check their diaper frequently for wetness (every 15min), this helps to decide when to schedule toilet trips.
  • Consider the individuals diet. Dietary changes, such as increasing the fluids and fibers in their intake helps the individual feel the urge to use the toilet.
  • Make small changes in daily habits. Dress the individual in easy to remove clothing. Change as soon as he or she becomes wet. Change diapers in or near the bathroom.
  • Make the individual flush the toilet and wash hands after each diaper change.
  • Make sure toilet trips are comfortable. The individual should be comfortable while sitting on the toilet. Provide a footstool. If the individual will not sit on the toilet, work on sitting before beginning a toilet training program.
  • Improve body awareness related to elimination and improve sensitivity to tactile stimulation from clothing.
  • Work on effective communication signaling that the individual needs to go to the bathroom and how to use systemic communication tools such as objects, pictures and words to communicate in different settings.
  • Imitation is a powerful strategy which can be used for toilet training individual with autism.
  • Developing routines and rituals is very important. This helps the individual to adjust to new situation such as using different toilet and serves as a bridge between old routine and new situation. Also these rituals and routines can be used to present toileting skills as a sequence of steps to provide the necessary sequential learning.

    In conclusion, teaching the basic toileting & hygiene skills is essential for social acceptance. It is an integral part of social skills training & becomes a higher priority with each passing year.

Stem Therapy Content

Behavior is basically everything a person does, says, thinks, and feels. A behavior issue simply means kids do or say things that they should not be doing or saying. On the other hand, it also means that kids are unable to do and say things that they should be doing and saying at their age. Children with autism exhibit behavior problems. Behavior is probably one of the most affected areas in Autism.

Having a behavior problem makes it difficult for kids with Autism to function in society, school, work, home, and community settings. Children with Autism may experience mild to severe difficulties in different aspects of behavioral functioning.

Below are several different areas of behavior in which children with Autism may experience difficulties. Not all children will have trouble in each of the listed areas. The level of difficulty will also differ from child to child. To deal with behavior problems, you as parents, teachers or caregivers should first make a list of all the behavior problems that the child is facing.

Attention Issues

One of the first signs that you might notice when kids are very young is lack of eye contact or responding to name. They do not engage or respond to interactive play such as “peek-a-boo”. As a child grows older, you might observe that your child is not exhibiting many of the skills or achieving milestones that he or she should, according to his or her age. For example, your kid does not start babbling on time or does not start showing interest in other children playing. He or she prefers to remain aloof and seems lost in their own world.

Social Communication Issues

The major behavior issues in autism are related to social communication and social interaction. Children do not develop the necessary language skills to interact with other children or people. They do not engage in conversations with others even if they have the necessary speech. Children do not mix with other children. They do not play with others. They cannot engage in social greeting such as saying or waving “hi”. They cannot form friendships or any meaningful relationships. They do not understand non-verbal communication such as gestures, body language. Also, they do not engage in non-verbal communication such as maintaining eye-contact, keeping their body oriented towards the person they are interacting with.

Repetitive Behavior Issues

Another defining behavioral issue observed in children with Autism is rigid or repetitive behavior patterns. They engage in stereotypical behaviors such as repeating the same action or routine over and over again. For example, they may flap their hands, line up objects obsessively, run around the room, etc. They may constantly repeat songs or dialogues. Sometimes you may notice they keep engage in non-sense talk. These behaviors interfere with appropriate functioning and learning.

Aggressive Behavior Issues

Children may also exhibit harmful behaviors such as aggression, self-injurious behavior, elopement, pica, or tantrums. They may hurt themselves or others when they engage in these behaviors. Also, these behaviors are hindrances to good or appropriate behaviors that enhance their social functioning.

Other Issues

Other areas that may be affected by Autism are academic performance and self-help skills. Children may find it extremely difficult to engage in school-related behaviors such as writing, reading, sitting in a classroom, attending to the teacher. Additionally, they have trouble taking care of themselves. They may have difficulties in bathing, tooth-brushing, eating, dressing, etc.

Kids with Autism exhibit these and other similar behavior difficulties. These behavior problems may harm children or may interfere with their learning. These behavior issues can impair their overall functioning and hinder progress in all aspects of life.

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