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Autism Community Network

Providing the weekly Medical Blogs are the team of professionals, doctors, occupational and behavioral therapists at San Antonio’s premiere Autism Diagnostic Clinic, the Autism Community Network.

Contributors include:

Executive Director Dr. Loree Primeau
Medical Director Dr. A Patricia Del Angel
Training and Research Director Dr. Berenice de la Cruz
Carrie Alvarado, OTR, PhD©, DIR/Floortime-Certified
Lupe Castaneda, MS, BCBA
Adriana Sanchez, MA, BCBA
Dr. Gayla Aguilar, OTR, OTD, C-SIPT
Megan Kunze, MA, BCBA
The ACN teams works to maximize the potential of children with autism through their administrative, clinic, training and development departments. Their expertise on Aspergers Syndrome is offered to you through aspergers101.com.

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Transitioning to Adulthood with Aspergers

Individuals diagnosed with Aspergers or another autism spectrum disorder (ASD) may be presented with many challenges throughout their lives—especially during the transitional periods. As the individuals age and learn to use different skills in various environments, families, educators, medical professionals and the individuals themselves begin to anticipate the transition to adolescence and, eventually, to adulthood. Given the differences in abilities and behaviors that many individuals with Aspergers or HFA experience, it can often be overwhelming to plan for tomorrow much less several years later.

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Among the many skills that an individual must learn to successfully transition to adolescence and adulthood, daily living skills are often neglected.

Examples of daily living skills are bathing, grooming, preparing meals, managing finances, using public transportation, etc. These daily skills are necessary for independent functioning in the home and within the community.

A recent study discovered that individuals with ASD improved in daily living skills during adolescence and the early twenties. These skills plateaued around late twenties and began to decline in the early thirties—this shows the importance of honing these skills earlier in life instead of waiting until later.

Some positive findings were that inclusive schooling had a positive influence on adult outcomes. The study also found, “that vocational independence predicts improvements in autism symptoms and significant improvements in behavioral problems.” Daily living skills could also be increased by engaging in some type of work activity.

It is encouraging that daily living skills can continue to be gained at later points in development as other skills plateau. The authors suggest that more research is needed to develop behavioral and pharmacological interventions for older individuals on the autism spectrum.

While individuals with Aspergers or HFA may have challenges with the daily living skills necessary for transitional periods, it is important for their independence and quality of life to begin this journey at an early age to ensure success.

by Lupe Castañeda, M.S., BCBA

Have you thought about or experienced the transitional periods in your or your child’s life?

How did you cope with these experiences? 

Sources:

Smith L.E, Maenner, M.J. & Seltzer, M. (2012). Developmental Trajectories in Adolescents and Adults with Autism: The Case of Daily Living Skills. Journal of American Academy of Child and Adolescent Psychiatry.  51(6): 622–631.

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5 Focuses For Creating a Learning Environment in the Home

When it comes to setting the stage for learning, individuals on the Autism Spectrum need to continue their learning experiences even after school. This requires responsibility from therapists, caregivers, and parents. Each must work together to help create a learning environment in the home that continues to provide opportunity to expand the vital skills a child is working on. This includes setting up a home environment, understanding your child’s classroom setup or making suggestions at their after school program.

Child playing at home

Here are five goals to focus on when evaluating a school-related learning environment in the home for children with Aspergers or HFA.

1. Increase Engagement:

It’s ok for kids to take a break after school and have some down time, but preventing total shutout is important. Whether it is a play activity or helping with homework, making this part of the routine will assist with expectations that the child will need to interact for an expected amount of time.

2. Increase Communication:

Asking the question “how was your day?” rarely gets the response desired. To get them to chat, incorporate out of the ordinary or silly situations to spark spontaneous requests or comments. (e.g. carrying an umbrella when it isn’t raining or dressing up the dog before your child gets home). Sometimes a child may need a prompt to take note about the change in environment, but that is ok! It increases the opportunity to communicate either way

3. Promote Independence:

Use visual charts to show the steps expected to follow directions without reminders. This is especially useful for morning and bedtime routines. It may take some time to teach the sequence to complete the task. However, using the visual will allow the child to find the solution on their own rather than get in trouble for not completing the task.

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Cognitive Behavioral Therapy for Individuals with Aspergers

Anxiety-related symptoms are frequent concerns in children, adolescents and adults with Aspergers and HFA, which may be treatable with Cognitive Behavioral Therapy.

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Anxiety is commonly found in high functioning individuals on the spectrum in particular because they have an increased awareness of their own social difficulties. This cognitive awareness may intensify their anxiety toward social interaction and promote isolation.

Recent numbers found that 11-84% of children on the autism spectrum experience impairing anxiety, while only 4.7% of all children aged 3-17 years have experienced anxiety.

Cognitive Behavioral Therapy (CBT) is a type of psychotherapeutic treatment that helps individuals recognize how thoughts and feelings influence behavior and cope with these challenges.

CBT is used to treat a wide range of issues, in addition to anxiety, including:

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The Two Types of Reinforcement for Individuals with Aspergers or HFA

Reinforcement in Applied Behavior Analysis (ABA) focuses on the outcome of the behavior and increasing the likelihood of certain behaviors occurring in the future. There are two types of reinforcement: positive reinforcement and negative reinforcement. Positive reinforcement is when a response is followed immediately by the presentation of a stimulus and, as a result, similar responses occur more frequently in the future.

In other words, positive reinforcement means when a behavior has an increased likelihood of occurring again if something is given after it occurs.

reinforcement

An example of positive reinforcement:

You tell a child if he or she cleans up their room, they can play for 30 minutes on the Wii, an activity they enjoy. The likelihood of the individual cleaning up the room is more likely to occur in the future because they received 30 minutes of playing with something they enjoy. In order for reinforcement to work, you need to make sure that what you are giving them is something that they value.

However, let’s change the reinforcement premise–

You instead tell the child if they clean the room you will go the movies. Your child is sensitive to sounds and does not like being around large crowds, so he will be less likely to clean his room even though you think it would be fun. The purpose is to focus on the child’s likes and dislikes to achieve the desired result.

Negative reinforcement is when a response is followed immediately by the removal of a stimulus and, as a result, similar responses occur more frequently in the future. In other words, negative reinforcement means when a behavior has an increased likelihood of occurring again if something is taken away after it occurs.

An example of negative reinforcement:

You are working on having the child be more independent when doing their chores. You provide a checklist of the chores that needs to be done for the day. He or she independently completes two of the chores on the list. You tell them because they independently completed two chores without any reminders, they do not have to do the rest of the chores. In the future, the individual is more likely to independently complete the chores because the rest of the chores were taken away—assuming he does not like any of the chores that were on the list.

If, however, they really like doing laundry and that was a chore on the checklist that you removed, the negative reinforcement will not have the desired effect on behavior.

You need to always keep in mind what the child likes and does not like. You give him or her things or activities that they enjoy and take away things that they do not like to increase the likelihood of the behavior occurring again in the future. If what you are presenting and taking away is not increasing the likelihood of the behavior in the future, then you are not using reinforcement.

by Adriana Sanchez, MA, BCBA

How do you use reinforcement with your child? What types of reinforcements are most effective, in your experience?

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ABA and Aspergers: The Three Step Plan You Can Use

The main use of ABA for individuals on the autism spectrum is to decrease challenging behaviors and increase appropriate skills.

Little girl hiding behind her hands - copyspace

Here are the three steps for utilizing ABA to decrease challenging behaviors and increase appropriate skills:

Step 1: Assessment

The first step in decreasing problem behavior is to conduct a functional behavior assessment, which determines the function of challenging behavior.

Appropriate skills including academic, language, and daily living skills are assessed in a similar way. The founding father of ABA, B.F. Skinner, wrote the book Verbal Behavior in 1957. In the book, language is analyzed based on the function. Assessments like the Verbal Behavior-Milestones and Assessment Program (VB-MAPP; Sundberg, 2008) are utilized to assess the persons’ language skills, as well as other appropriate skills like academic and daily living skills.

Other assessments utilized in ABA are the Assessment of Basic Language and Learning Skills-Revised (ABBLS-R; Partington, 2006) and the Assessment of Functional Living Skills (AFLS; Partington & Mueller, 2013).

Step 2: Developing a Plan and Treatment Goals

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Are You a Visual Thinker? Understanding the Difference between Visual and Auditory Input

Tools to Decrease Neurological Stress

How do we decrease neurological stress?  The following is an excerpt from my recent book titled “Visual Supports for Visual Thinkers: Practical Ideas for Students with ASDs and Other Special Educational Needs”

Visual processing

A research team funded by the National Institutes of Health found that, in people with autism, brain areas normally associated with visual tasks also appear to be active during language-related tasks. This provides evidence to explain a bias towards visual thinking that is common in those with autism.

Try this little activity: the following statement is about neurological processing.

“Visual’s a strength, auditory ain’t.”

As you say this, make goggles with your hands to cover your eyes. Then try saying it again while cupping your hands to make ear muffs over your ears. This little exercise will help your brain to remember a key statement about the preference for those with ASD for visual versus auditory learning. This understanding is the first step for taking a different course of action when responding to the behavior of those struggling with neurological stress.

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Treatment for Sensory Processing Disorder

Sensory processing disorder (SPD) can make participation in life activities—what occupational therapists refer to as occupations—very difficult. Luckily, there are options and strategies to help improve sensory processing and make life much smoother and more enjoyable.

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Sensory-based occupational therapy (OT), may look like play to adults, but to the child it is their work and necessary for improving overall abilities to process sensory information more appropriately. Jumping, swinging, climbing and playing in multisensory mediums—such as shaving cream, beans, rice, or play dough—all have a place in their growth and the development of sensory processing abilities.

As the child plays and learns more about their body and how to use it through treatment for sensory processing disorder, their brain improves its ability to process sensory information more efficiently. These children are then able to handle situations more appropriately and participate in everyday activities including self-care, fine motor and social skills.

This process can take months for long lasting effects, but parents often see a difference after the first few visits.

Occupational therapists that specialize in SPD and autism are especially adept at helping individuals on the spectrum succeed. These therapists are skilled in testing and providing treatment, compiling strategies to modify the environment, developing home programs, and giving suggestions to schools and vocational programs to improve participation in life’s activities.

When looking for an occupational therapist, it is important they have advanced training in sensory integration or SPD and, if possible, are SIPT (Sensory Integration and Praxis Test) certified.

Though occupational therapy services may be provided in a variety of settings—including home and school—the clinical setting is much more conducive to treating SPD and the underlying causes of the child’s difficulties. This is because a clinic will have specific equipment designed to promote engagement in therapy and develop skills necessary to overcome sensory difficulties.

You also want to make sure they have an OT gym that is well equipped to treat SPD.  A phone call and an interview with the therapist may be beneficial.

Find a SIPT Certified Therapist

by Dr. Gayla A. Aguilar, OTR, OTD

Does your child have a sensory processing disorder? How does your occupational therapist help?

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Motivation for Those with Aspergers: Using Reinforcement Effectively

Motivation is key when using reinforcement to change the behavior of individuals with Aspergers or HFA.

When you think about it, it makes sense that motivation is at the center of it all. If a child or individual is motivated, they are more willing to make certain changes in their behavior and do what you want.

Highway road going up

Using motivation as a behavioral tool for change occurs for neurotypicals as well. For example, if there is a position available at work that someone wants, the individual will modify their behavior to increase the chances of obtaining that position.  The specific change in behavior is a direct result of motivation (as in wanting the position).  If the position was not available, the person would less likely be engaging in the changed behaviors.

That said, there are two ways to manipulate motivation:

Deprivation

Deprivation means reducing the amount of access your child has to the reinforcer, also known as the item or activity that will be used to motivate the child to increase or decrease behavior. Deprivation increases the value of the reinforcer.

Example:  If a child absolutely loves Cheetos but has free access to them, a behavior analyst would use deprivation to increase the value of the Cheetos. Now the child can only access them if he or she performs as expected. Since the child has less access to the Cheetos but still loves them, the child is more willing to do what is asked to obtain the Cheetos—motivation.

Satiation

Satiation, on the other hand, means increasing the amount of access your child has to the reinforcer. Satiation is meant to decrease the value of the reinforcer, which is something to keep in mind when choosing a motivational tool.

Example: If a teenager receives an iPad, an object he is fascinated with, as a reinforcer and is the only reinforcer being used, it is likely that after a period of time the child will lose their interest in the iPad resulting in satiation (the iPad no longer has a strong value).

Behavior Analysts use deprivation to increase the value of the reinforcers to motivate the individual with Asperger’s or HFA, and are cautious of satiation to make sure the reinforcer does not lose its value. This encouragement can be used to help them to adapt in a situation or adjust behavior appropriately.

by Adriana Sanchez, MA, BCBA

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Social Language or “Pragmatics”

Your child may not know how to use language appropriately in social situations. This undeveloped social skill can cause your child to unintentionally say harmful or rude comments to others. Even when able to say words clearly in complex sentences with correct grammar, a child still may have a communication problem – if they have not mastered the rules for social language known as pragmatics.

Speaking head

Pragmatics includes three major communication skills:

  1. Using language for different purposes

    • greeting (e.g., Hello, goodnight)
    • informing (e.g., I’m going to go to bed now.)
    • demanding (e.g., Turn out the lights, please.)
    • promising (e.g., I’m going to wake up early and make waffles.)
    • requesting (e.g., I would like an extra blanket.)

  2. Changing language according to the needs of a listener or situation

    • speaking differently to a toddler than to an adult, or with a sibling vs. a teacher
    • sharing background information with an unfamiliar listener
    • speaking differently in a movie theater than on a playground

  3. Following rules for conversations

    • turn taking
    • introducing a topic of conversation
    • staying on topic
    • rephrasing when misunderstood
    • using verbal and nonverbal signals
    • knowing how closely to stand to others
    • using appropriate facial expressions and eye contact

Remember: It is important to understand the rules of your communicative situation.

An individual with pragmatic problems may:

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How to Expand A Picky Eater’s Diet: Feeding and Food Chaining

Since feeding involves all sensory systems (sight, smell, sound, touch, and taste), eating is the most difficult sensory task that children face. Feeding issues are especially common in children with autism, including those with Aspergers, because of difficulties with sensory processing. In many cases, this leads to eating challenges at mealtimes.

Little girl eating

“Food chaining,” from the book by the same name, is based on the child’s natural preferences and successful eating experiences—specifically the idea that we eat what we like. Food chaining introduces new foods that have the same flavors or sensory features as foods that are already preferred by the child, increasing the likelihood that the child will like the food.

A food chain consists of four levels that build upon one another. By following the levels of the food chain, the child will be able to build upon success with small changes.

For example, if your child’s accepted food is chicken nuggets, a sample food chain might look like this:

Level I Level II Level III Level IV
Maintain & Expand Current Taste & Texture Vary Taste & Maintain Texture Maintain Taste & Vary Texture Vary Taste & Texture
Other brands and sizes of chicken nuggets (i.e., strips/popcorn/bites, both fast food & home-prepared); fried chicken patties cut into pieces (fast food & home prepared) Different flavored chicken nuggets (barbeque, honey mustard, hickory smoked, etc.) Use sauces/dips to vary tastes. Chicken strips (not breaded); chicken leg/drumstick; chicken breast; ground chicken patties Breaded seafood (scallops, shrimp); breaded fish (fast food & home-prepared); breaded turkey breast; breaded vegetables; breaded baked chicken; crusted/breaded pork tenderloin; ground meats

Here are some other food chaining tips: