HOME TRAINING FOR AUTISM

Edited by: KUNNAMPALLIL GEJO JOHN, SPEECH LANGUAGE PATHOLOGIST

Autism is a brain development disorder characterized by the characteristic triad of

symptoms: impairments in social interaction; impairments in communication; and restricted

interests and repetitive behavior. These signs all begin before a child is three years old. The

prevalence of ASD is about 6 per 1,000 people, with about four times as many boys as girls.

Most parents of autistic children suspect that something is wrong by the time the child is 18

months old and seek help by the time the child is 2. Children with autism typically have

difficulties in:

Pretend play

Social interactions

Verbal and nonverbal communication

The symptoms may vary from moderate to severe.

Communication:

Cannot start or maintain a social conversation

Communicates with gestures instead of words

Develops language slowly or not at all

Does not adjust gaze to look at objects that others are looking at

Does not refer to self correctly (for example, says "you want water" when the child

means "I want water")

Does not point to direct others' attention to objects (occurs in the first 14 months of life)

Repeats words or memorized passages, such as commercials

Uses nonsense rhyming and syllables

Screams loudly

Social interaction:

Does not make friends

Does not play interactive games

Is withdrawn

May not respond to eye contact or smiles, or may avoid eye contact

May treat others as if they are objects

Prefers to spend time alone, rather than with others

Shows a lack of empathy

Response to sensory information:

Behaviors like aggression, frustration, or withdrawal, which seem inappropriate, are often due to

the childrens sensory integrative dysfunction, which they are unable to articulate and express

through spoken communication. Sensory input is not integrated or organised appropriately in the

brain. This produces varying degrees of problems in development, information - processing and

behaviour.

Does not startle at loud noises, In some cases child shows hyperacusis.

Has heightened or low senses of sight, hearing, touch, smell, or taste

May find normal noises painful and hold hands over ears

May withdraw from physical contact because it is overstimulating or overwhelming

Rubs surfaces, mouths or licks objects

Keeping food in mouth

Seems to have a heightened or low response to pain

Excessive gag reflex and gastro intestine problems

Play:

Doesn't imitate the actions of others

Prefers solitary or ritualistic play

Shows little pretend or imaginative play

Solo play

Behaviors:

"Acts up" with intense tantrums

Gets stuck on a single topic or task (perseveration)

Has a short attention span

Has very narrow interests

Is overactive or very passive

Shows aggression to others or self

Shows a strong need for sameness

Uses repetitive body movements

Shadow watching and palm watching

Other signs include craving for or recoiling from movement, flapping hands, spinning around,

uneven gross and fine motor skills, spinning and rolling objects, unusual attachment to certain

objects.

MANAGEMENT

Appropriate early intervention is important. Once the diagnosis has been made, the

parents, physicians, and specialists should discuss what is best for the child. In most cases,

parents are encouraged to take care of the child at home along with speech therapy at the clinic.

Further, mainstreaming at school level is a major goal.

A two pronged approach is meaningful:

o Helping the autistic child emote smile, express affection, relate to peers and so

on.

o Helping the autistic child to acquire skills that help him/her deal with the

environment.

As parents, these are the few goals and activities which can be followed to help the child achieve

better speech and language and become a more independent and contributing member of the

society. Caregivers should remember that therapy is not a one time/short span effort. It is a

continuous process.

1. Try to make eye contact with the child.

Eye contact is a basic skill and is one of the prerequisites for learning. Eye contact may be

encouraged by talking to the child at his/her eye level. Whenever you give a certain object to the

child (eg: Food), be sure to keep the object at your eye level so that the child see your eye when

he tries to receive the object. The child must learn to associate the eye contact behavior as a

means to some positive reinforcement. Keep in mind to grade the activities and reinforcements in

accordance with the skill level of the child- as the child progresses, your expectation must also

get higher so that you reinforce only higher skill levels.

Eg: When the child learns to make that fleeting eye contact to obtain the objects, hold on to the

object for a few more seconds while asking the child-Do you want food? so that he learns to

maintain his eye contact for a few more seconds.

* Keeping a candle, any attractive object in front of your face, wearing mask as you speak are

also effective means of establishing and improving the eye contact.

2. Use of childs name-Name call

Taking the childs name every time he is addressed is essential. However, pronouns should be

taken care of while talking to him since most autistic children who talk tend to reverse pronouns,

using You instead of I and vice versa. So it may be better to say, Rahul, YOU can have

toast, rather than Rahul can have toast.

3. Daily routine

Organise the childs environment and daily activities into a routine. Autistic children respond

well to routine, which helps them to create order in their world. This could be done by keeping

fixed times for food, play and other activities like taking a bath, sleeping, etc.

Provide prior warning of any change in routine - physical or otherwise. For example, if the

furniture of the childs room needs to be moved, the child should be told and allowed to get used

to the idea, before the change is made.

4. Learn to apply the Reinforcement strategies

Positive reinforcement: This is the reward given to the child to encourage and maintain the

positive behaviors. These reinforcements vary from things to eat to clapping, pat on the back,

letting him do something he likes (eg: playing with blocks). Initially, the reinforcements must be

immediate and must be something which he likes very much. eg: small pieces of biscuits.

Gradually, we can shift to token reinforcements (eg: labels) and reinforcements must be given

only when higher skill levels are demonstrated.

Negative reinforcement: Ignore the childs negative behaviors like temper tantrums. Getting

angry at the childs tantrum will not help. Infact, it only increases the behavior due to unwanted

attention given. When the child exhibits an undesirable behavior, the child must be ignored

(forgetting that he is present in the room) for some time. The child often sees you as a way of

fulfilling his needs, and when they are ignored consistently on exhibiting certain behaviors, there

will be a gradual reduction in that behavior.

5. Social skills

How to greeting people, waiting for his turn must be taught by letting the child take part in the

daily activities carried out at home. Eg: He must learn to wait for his turn to get the plate filled

for eating.

6. Breakdown and Sequencing

Parents may need to break difficult tasks down and outline it into small, teachable steps. For

each step of a difficult task, the child needs to have the basic skills. These sub-skills may need to

be taught and strengthen in order. For example, when teaching a self-help skill such as brushing

teeth, the task may need to be broken down into sub-skills:

getting the toothbrush and toothpaste, turning on the water, wetting the toothbrush, unscrewing

the lid of the toothpaste, putting the toothpaste on the toothbrush, etc. Life skills, social skills,

and academic skills can all be considered and approached as tasks and sub-tasks, with each step

taught and then linked to the next in a series sub- tasks.

7. Make the child independent

Let him do simple works of his by himself like opening the door, keeping the lunch box in the

bag, zipping his bag, wearing the shoes, brushing teeth or washing plates etc. Initially, you must

manipulate his hands to do the work as you give the command. Gradually, reduce your

participation and dont forget to praise him when he finishes the job. Take care to keep your

commands simple and not loaded with descriptions and repeat the same message the next day so

that he becomes adjusted to the routine.

8. Talk to the child in simple and uncomplicated language

Long and subtle sentences should be avoided. For example, instead of saying, Rahul, would you

please come and sit here, it is better to say, Rahul, sit here while pointing to the destination

with a finger.

The child should be talked to often, rather than waiting for him to initiate conversation. Any

effort to talk on the childs part should be effusively praised. Gradually the child can be

encouraged to initiate conversation on his own.

9. Importance of Repetition

Be ready to repeat the instructions again and again to the child. We must understand that the

child has a sensory organization difficulty and may not understand what you say the first time.

Learn to develop patience and give repeated directions clearly and unambiguously.

Eg:

Mother: John, pick up the shoes.

John continues looking out of the window.

Mother touches him and repeats by pointing John, pick up the shoes.

John picks up the shoes and keeps it in the rack while the mother helps in the activity.

Mother: Good! Here, you can have your snack.

9. Use your childs strengths and preferences

Play and music are modes that can help an autistic child learn. Play some light music as you help

him learn various activities. Use rhymes and songs and play with him using hand, leg, finger

movements.

*Use the visual mode-

It has been seen that children with autism understand better with the visual mode than any other

modes. So, use the visual mode along with other modes.

For example, while telling a story, the child should preferably be shown a picture book

simultaneously. Unlike other children, an autistic child might like to hear the same story

everyday providing him with a sense of routine and order.

*Have a chart with pictures of his daily activities in it-This is called a visual schedule. Explain it

to him before the activity is to be done along with the auditory input. This not only helps him

understand what he is expected to do, but also what comes next and when he will be doing his

preferred activity.

Visual supports are very useful and can be used to:

Organize the childs daily activities, schedules, calendars, and choice boards with colored

picture cut outs.

Provide directions or instructions for the child through visual display of home, flash cards with

directions for specific tasks and activities, by drawing or a graph or chart with symbolic figures

representing a certain number of people, places, foods, etc. with written instructions for learning

new information.

Assist the child in understanding the association of their surroundings by labeling of objects

around the home.

Support appropriate behavior by posting rules and images to show daily routine.

Teach social skills - illustrate social stories by describing a social situation with the social clues

and appropriate responses, developed for a specific situation for the individual child. The most

effective plan for a story is a booklet with one or two sentences on each page, and a single page

including one situation.

Teach self-control - drawings, which offer cues for behavior expectations. Choose visual aids

on the basis of understanding of the student and her or his abilities and response.

10. Social interaction-

As the child learns to interact with you and a few close persons, introduce other children and

persons into the group. Take care not to rush him and let him approach the person in his own

time, initially. As he learns to accept others around him, he can be taught parallel play, and

gradually, social play.

When he starts getting comfortable with people, start taking him to market places, teach him to

greet them, answer questions etc.

Remember that each child is different. You can create your own activities based on the childs

interests and inclinations. Be sure to ask as any questions or doubts which may occur to you

in the process and be hopeful and confident!

kunnampallilgejo@gmail.com

Note: This document was took from AIISH, Mysore and add some points.