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Parents with children who have autism have the challenge of identifying and providing their child with treatment and choosing among the myriad of different treatment options. The information in this section contains treatment for children with autism offered specifically at the Autism Diagnostic Clinic and Psychological Services, and these interventions should be used in conjunction with other teaching methods. A general overview of treatment alternatives is discussed at length in the Autism Playbook section.

Children with autism have unique mental health issues. (“Autism” in this website’s context also refers to Asperger’s Disorder.) Treatment provided at the clinic includes behavioral supports, social stories, social skills training and social referencing. Behavior supports also involve providing functional assessments to address maladaptive behavior. These interventions focus on observable outcomes. There are several interventions and/or recommendations that are offered usually based on the results of the psychological evaluation including general social skill acquisition, socialization and leisure opportunities, behavior management, support and advocacy information for the IEP process, and sibling support. Referrals include various service agencies, medical referrals, and referrals related to the need for adjunct medication. The following sections provide information on behavior supports, social stories, and social skills training.

 

Behavioral Supports and Functional Assessments

There are many reasons for “behavior problems” in children with autism. Behavior is functional….for all of us. It is important to identify the reason for behavioral challenges or changes.

  • Sensory overload can cause or maintain “behavior problems”

  • Attempts to escape task demands are common

  • Hyper-arousal levels oftentimes interfere with a child’s ability to attend, sit still, or interfere with emotional and behavioral regulation.

  • Mood disturbances are 4% to 6% more common in individuals with developmental disabilities, and the behavioral endpoints of increased irritability (especially early morning), mood swings, unusual sexual curiosity, increased aggression, etc. are not uncommon.

  • Driven motor or vocal movements (called stereotypies) are common in children with autism. Oftentimes, they are unable to keep their hands still or refrain from humming, talking, singing, etc.

  • Poor planning in routine transitioning can be most upsetting and may subsequently elicit responses/behaviors that appear extreme

  • Other functions of maladaptive behavior include tangible functions (when they want something), escape function (when they do not or cannot complete task demands), physical function (mood, illness, arousal levels, medication side effects, self-stimulatory, etc), seeking attention, and/or seeking to be left alone.


One of the first signs of autism is a child’s inability to regulate sensory input, such as in processing smell, touch, movement, tactile, visual and auditory stimuli. Typically there is either a “hypo” or “hyper” sensitivity to the senses. A child may act as if they cannot hear you or sounds that we cannot even hear may hurt a child ears. A child may act as if it hurts him or her if they are touched or held and even simple things like tags in clothes or seams in socks appear to cause pain. Other children may seek touch; they love being tickled, wrapped tightly, etc. Some children seem to be in constant motion while others have very low levels of arousal. All of these different sensory registration levels are believed to be related to the cerebellum in the brain. The cerebellum affects the ability of the person to regulate the sensations or the environment and may thus cause difficulty in understanding and using of language (Janzen, 1996). Language and sensory dysfunction are interconnected. This is the reason we advocate for intensive OT and Speech-language therapies as part of early intervention. It is easy to see how these sensory input issues impact behavior.

We also support and encourage the use of positive behavior supports (PBS). This approach focuses on more than just decreasing problematic behavior. PBS incorporates an individual’s lifestyle, making environmental changes, and teaching new skills rather than focusing directly on reducing the problem behavior. PBS is a set of research-based strategies used to increase quality of life and decrease problem behavior by teaching new skills and making changes in a person’s environment. Positive behavior support combines valued outcomes, behavioral and biomedical science, validated procedures, and systems change to enhance quality of life and reduce problem behaviors (e.g., self-injury, aggression, property destruction, pica, defiance, disruption, etc.). The prevailing goal of PBS is to enhance quality of life for individuals and others within social settings in home, school, and community settings.

We routinely utilize the Functional Behavior Assessment (FBA) Profiler as part of the social-emotional assessment in a psychological evaluation. To our knowledge, it is the only tool that identifies not only maladaptive behavior patterns, but also the function(s) of that behavior and associated clinically syndromes. Interventions based on the functions are offered. At times, the instrument is utilized to obtain general data across settings that are pertinent to intervention. The FBA website allows free trials and parents and teachers are encouraged to use. Follow the link to the FBA website: www.ldinfo.com/fba1.htm

 

Social Stories

Social stories are useful to assist children with autism to learn. A social story is a short story that is designed for a specific child with a specific need. Carol Gray is the pioneer of this method. The story describes to an individual the relevant social cues and common responses in a specific situation, and it helps to explain the “what and why” of the situation. It can also help to prepare an individual for an uncertain event, to share information, and provide strategies. Social stories can be used with children of all ages, and should be based on the child’s specific needs. With older children, social stories are oftentimes incorporated into their therapy sessions as a learning tool.

A parent can also use social stories with their child as an intervention to address specific behaviors, situations, or events. The general guidelines for using a social story are defined as follows:

  • Select a behavior that would increase a positive social interaction for the individual and break it down into sequential steps

  • Define the target behavior concisely

  • Collect data about the target behavior before, during, and after using a social story as an intervention

  • Help the individual to generalize the story across situations through different activities and experiences

  • Gradually fade out the use of the story


We also use social stories within a small group setting, as having an additional goal of learning about the group members. There are several components to a social story, and they are generally comprised of four types of sentences:

  • Descriptive Sentences: Describe where a situation occurs, who is involved, what the individuals are doing, and why.  They are used to describe a social setting or to provide sequential steps for completing an activity.

  • Perspective Sentences: Describe how others feel and react within a given situation.  They are designed to reflect others’ perspectives.

  • Directive Sentences: Describe the responses and actions the person should ideally make in a given situation. The desired behavior is defined in positive terms.  The sentences often begin with “I can try to...” “I will work on....” or “I will try.....”

  • Control Sentences: Describe strategies the individual will use to help him/her remember the social story’s information.


*Sentence information adapted from http://members.spree.com/autism/socialstories.htm

Examples of social stories have been adopted with permission and can be found by following this link.

 

Social Skills Training

Social skills are typically defined as those abilities related to communication, problem-solving, decision making, self-management, and peer relations. These abilities allow an individual to initiate and maintain positive social relationships with others. Both deficits and excesses in social behavior interfere with learning.

Terms and Definitions: The term “socially skilled” involves an individual’s ability to respond to a given environment in a manner that produces, maintains, and enhances positive interpersonal effects.

Social competence is defined as one's overall social functioning or an individual’s composite of generalized social skills. Research has shown that social competence is linked to peer acceptance, teacher acceptance, inclusion success, and post school success. Social competence can be improved by teaching social behaviors/social skills.

Social referencing is the ability to use other people’s emotional reactions as a critical reference point for subsequent behavioral responses. Typically, social referencing is utilized to respond to confusing, unexpected or ambiguous stimuli.

Children with autism lack the skills to negotiate social interactions. These skills must be taught just as all other skills are taught, and the method of teaching is different for individuals with autism. That is, methods such as discrete trial training, visual supports, and Relationship Development Intervention (RDI) are utilized.

Children with autism typically do not attend to cues in the environment and therefore experience very little ”incidental learning” of social skills. For instance, a typical developing child learns the subtle social cues of his or her peers and this information provides a feedback loop. Do not assume your child understands or can negotiate even the simplest social interaction. But the good news is that children with autism can acquire social skills just as they acquire other skills, and there are things parents and educators can do to facilitate learning.

Some therapies teach social scripts, or discrete behaviors, while other therapies incorporate the acquisition of social referencing skills. This type therapy teaches the child with autism to connect socially and emotionally with others, and to welcome living in a life of dynamic change.

Social skill training for autism has some special considerations. The Theory of Mind refers to our awareness of other’s intentions, desires, emotions, etc., and usually this awareness is attained by the age of four in typically developing children. However, it may not emerge in children with autism until ages nine to fourteen years. This “awareness” is fundamental to social interaction.

Also, atypical sensory integrative experiences result in atypical perceptions. As such, there is a good probability of an “atypical reaction” to any given social situation because the reaction is based on “flawed” information. These deficits manifest in several ways. It is often difficult for individuals with autism to predict behavior of others, read their intentions, and/or understand their motives. Such a misunderstanding “looks” as though they lack empathy. Individuals with autism likewise have a difficult time explaining their own behavior.

Collectively, these deficits lead to defective social feedback loop. When a feedback loop is missing or defective, individuals with autism have a propensity to make more global attributions. It may also impact motivation, and they may feel “defective.” Teaching social skills in the correct manner conveys the value that “mainstream culture” is neither right nor wrong but simply different.

Tools are needed to get what you need or want in the mainstream culture (i.e., eye contact, smiling at peers, etc). Social skills should be “strength-based” or driven. It can be helpful to use their restricted interests as a starting point. For example, help them to understand their own idiosyncrasies and those of others by using references to what the child knows and shows interest in (e.g., just like Ninja Turtle—Pokemon-SpiderMan have different powers, people have different strengths and talents as well as shortcomings).

Groups for children with autism typically have two or three members and we meet on a weekly basis. For children, the groups are chosen based on assessment results, ages, and level of need.

**Note: We also offer social skills training for a variety of other disorders and/or reasons. We currently have ADHD adolescent groups, middle school groups, etc. Many children never learned "appropriate behavior" for social settings-situations in which they must interact with others. Perhaps they had good role models in the home and neighborhood who promoted "appropriate" behavior, but didn't pick it up as well as most kids. Children with ADHD have deficits in attending to the social cues in the environment just as they have difficulty with other tasks that require them to attend and encode information. ADHD oftentimes encompasses behavioral endpoints (e.g., intrusiveness, impulsiveness, interrupting, etc.) that can respond to appropriate treatment.

 

No Referral Needed

DISCLAIMER: Autism is a complex disorder. The information presented here is designed for informational purposes only and is presented as a public service. The contents of this web site are not medical, legal, or technical advice and must not be construed as such. Dr. Marsiglia’s “opinions” are based on research but are nonetheless opinions only. The information contained herein is not intended to substitute for informed professional diagnosis, advice or therapy. The website information is not for diagnosis or treatment without personal consultation.


 

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