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DSM-5 Changes: Autism Spectrum Disorder

July 23, 2013

by Marilyn J. Monteiro

Did the definition of autism change with the DSM-5?

 In May 2013 the American Psychiatric Association published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), changing the definition of autism spectrum differences. Instead of using the terms “Autistic Disorder,” Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), “ and “Asperger’s Disorder” all forms of autism are now called Autism Spectrum Disorder.

 Three Levels of Support now distinguish the spectrum of autism differences, with the following distinctions: Level 1 Requiring Support, Level 2 Requiring Substantial Support, and Level 3 Requiring Very Substantial Support.

 Differences in development are divided into two categories for Autism Spectrum Disorder: Social Communication and Restricted, Repetitive Behaviors.

 How do these changes fit with the three terms we have been using up until now?

 Think of each of the three Levels of Support as roughly corresponding to Autistic Disorder, PDD-NOS and Asperger’s Syndrome, with Level 3 corresponding approximately to Autistic Disorder, Level 2 to PDD-NOS, and Level 1 to Asperger’s Syndrome.

 How do these changes fit with the Descriptive Triangle?

 The DSM-5 uses two areas instead of the three areas highlighted in the Descriptive Triangle.

 The first DSM-5 area, Social Communication, combines two areas of the Descriptive Triangle: Language and Communication and Social Relationships and Emotions.

 The second DSM-5 area, Restricted, Repetitive Behaviors, corresponds to the Descriptive Triangle area of Sensory Use and Interests.

 Although the DSM-5 combines Language and Communication and Social Relationships and Emotions into one area—Social Communication—it is helpful for evaluators, parents, and clinicians to look closely at the distinctive behavioral differences within an individual’s use of Social Communication. Language differences, understanding and use of social cues, and emotional regulation issues all fall under the umbrella of Social Communication. The Descriptive Triangle helps clinicians identify specific and nuanced behavioral differences within the broad area of Social Communication.

 Although the DSM-5 requires the use of the language Restrictive, Repetitive Behaviors when making a diagnosis, it is useful for clinicians working directly with children to identify the child’s differences in the area of Sensory Use and Interests, as this wording leads clinicians to describe the positive attributes associated with the child’s interests and the self-regulating qualities that are an integral part of the child’s sensory-seeking routines.

 Click here AC and Levels of Support for a Quick Reference Chart connecting the DSM-5 changes to my Descriptive Triangle framework.

 

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Making Sense of Noncompliant Behavior

March 7, 2013

by Marilyn J. Monteiro

He only wants to do what he wants to do when he wants to do it. Then he tantrums or resists following my directions when it’s time to stop doing what he wants to do. He knows what he’s doing so it couldn’t be autism.”

This is a theme I frequently hear when teachers or colleagues are in the process of evaluating a child for a possible autism spectrum difference.

 So how do you make sense of the distress and agitation triggered by students during the transition from a preferred activity to one that is directed by the teacher?

 This is a common pattern seen in children with autism spectrum differences. Oftentimes we assume the child is engaging in resistant behaviors because he or she is willfully choosing not to comply with the adult’s request. However, with children who have autism spectrum differences in the area of sensory use and interests this resistance during transition times involving the transition from a preferred activity to a less preferred activity may be better understood as a function of the child’s sensory attachment to the preferred activity and the subsequent difficulty in shifting his or her attention from the highly preferred activity to following the agenda of the adult. Compounding this shifting difficulty is the fact that most of the time transitions are signaled when the adult talks to the child as directions are given and requests are made. Incoming language demands are frequently sources of stress and agitation for children with spectrum differences—even when the child is highly verbal. 

 This understanding of the underlying triggers for the behaviors of noncompliance and resistance to directions—and the accompanying emotional dysregulation in the form of anger outbursts and agitation—as being related to the child’s restricted range of interests, engagement in repetitive activities and resistance to changes in routine is important. 

 Why is this distinction so important? Because when we interpret the child’s resistant behavior as willful or noncompliant, the strategies that come to mind involve the use of consequences and verbal explanations to the child regarding the consequences for noncompliance. We assume the child is capable of making the choice of moving with ease from the preferred to the non-preferred activity as long as the consequences we provide are powerful enough. 

 What we miss with that interpretation is the information the child is giving us regarding the function of the preferred activity. If we entertain the idea that the child is seeking out the preferred activity as a way to regulate input then we can begin to get curious about the form and function of the preferred activity. Usually the activity is solitary, involves visual, familiar, and repetitive input, may have a predictable auditory component, and is under the control of the child. In other words, the sensory dimensions of the preferred activity (computer, books, specific toys or materials) serve the function of providing the child with a sensory regrouping time within the social and language-based environment of the classroom. The repetitive and solitary nature of the preferred activity serves as a way to block out incoming language and social demands, and provides the child with a way to self-regulate. In other words, it serves an organizing function for the child. 

 Once we understand the behavior through the sensory regulation and organizing framework we are led to different interventions. Specifically, we know that child will need a visual cue to signal the upcoming transition from the child’s agenda to the agenda of the teacher. The use of a visual cue serves two purposes: the adult direction goes in through the child’s strongest channel (visual versus auditory) and the adult is less likely to bombard the child with verbal directions (a trigger for disorganized and dysregulated behavior). 

 We can also look at ways to build sensory regrouping breaks using the preferred activities into the child’s daily routine. For higher functioning children we can use a visual cue such as a battery that gets recharged as the child engages in brief sensory breaks. As the child engages in the preferred activity his or her battery fills up and the child is ready to work. This type of visual tool helps the child visualize the internal process of regrouping when engaged in the preferred activity. The challenge that we face at the outset is that the child has set up a routine of selecting the preferred activity and then resisting the transition. In the routine established by the child we lose the opportunity to use the organizing function of the preferred activity as a springboard to effective participation in other activities. 

 The sequence of work-break-work-break has to be taught by creating repeated successful cycles of transitioning from the preferred activity to the less preferred activity and then back to the preferred activity. Many children resist leaving their preferred activity because they have difficulty anchoring the idea that they will have additional opportunities to engage in their preferred activity throughout the school day. Children with autism spectrum differences respond well to the use of visual transition cues, visual ways to understand the function of the sensory regrouping breaks, and the establishment of work-break-work-break routines. The addition of social scripts that lay out the narrative for the child to understand the function of their preferred activity (recharge the battery/regrouping break) is useful in that the child gains an understanding of how the preferred activity fits into his or her school day.  

 The challenge is for us to consider the possible underlying function of the resistant behavior as being sensory-based rather than based in willful noncompliance. 

So the next time someone describes a child’s behavior by telling you “he only does what he wants to do when he wants to do it,” or something along those lines, get curious about the preferred activity.

 Here are some statements and questions that get the sensory conversation started:

 Tell me more about the child’s preferred activities.

 Does he/she select activities that are solitary/self-directed/three-dimensional/low verbal and social demand?

 Is it possible that the activity helps the child block out language and social demands?

 What do you say to the child when it is time to change activities?

 Do you “show” as well as “tell” the child what you want him/her to do?

Tell me about times when the child successfully transitions from a preferred activity to a non-preferred activity.

 

 

 

 

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Australian Workshops and Travel

September 6, 2012

by Marilyn J. Monteiro

No worries.

 Good on you.

 How’re you going?

 Essendon Bombers.

 Mooloolaba.

 These are additions to my vocabulary after spending two months in Australia.  I had the opportunity to work with Tony Attwood for several weeks, collaborating on sessions with families and co-presenting a two-day training for professionals in Brisbane.  We enjoyed exchanging ideas and found that our styles in approaching families were compatible and complimentary. I very much appreciated Tony’s invitation to visit and collaborate in Brisbane. We hope to have future opportunities to provide joint trainings in the United States, Australia and Europe. Anyone interested in arranging joint training workshops can contact Tony www.tonyattwood.com.au or me.

 The Australia Council for Educational Research (ACER) sponsored my three training workshops: a two-day training in Brisbane, and one-day trainings in Melbourne and Sydney. I very much appreciated Li-Ai Lim’s invitation to provide these trainings through ACER. Li-Ai is ACER’s Product Manager for Assessment. The ACER staff made my time in Brisbane, Melbourne and Sydney memorable in every way.  I’m happy to now have colleagues in Australia, including Amanda Coleiro, Eirini Lammi, Blair Heading, Laura Beckett, Debbie Lee, Marian Power, and Yana Gottmaker. Thank you for your warm hospitality and enthusiasm regarding the content of the workshops.  I look forward to our future collaborations.

 LaTrobe University in Melbourne has a newly established autism research center and I was fortunate to spend a day there. Cheryl Dissanayake is the psychologist who directs the Olga Tennison Autism Research Centre (www.latrobe.edu.au/otarc) and we enjoyed discussing the work her teams are doing with young children as well as discussing best practice autism evaluation methods. Cheryl and her team have begun to incorporate my Visual Framework into the way they discuss the autism spectrum diagnosis with parents. We hope to collaborate on a research project that target how to best deliver the diagnosis to parents.

 So what about the phrases at the start of this post?

 Try saying ”no worries” a few times a day and you may find yourself less stressed.

 “Good on you” is a way to recognize something you’ve done or some good fortune that has happened to you. Sort of like congratulations or nicely done.

“How’re you going?” is another way to ask: How are you?

The Essendon Bombers are an Australian Rules Football Team based in Melbourne. Thanks to Colin Reis and Julie Contole, my husband and I were able to see a live game and learn the rules from Colin, a lifelong fan.

Mooloolaba (pronounced Mooloolaba) is a town in Queensland on the Sunshine Coast just north of Brisbane. The beaches are beautiful, the people are great, and I dubbed it the “St. Petersburg of the Southern hemisphere” because in some ways it was similar to the beaches and beach culture in that part of Florida. Like many places in Australia  Mooloolaba is derived from an Aboriginal name.  It comes from one of two possible Aboriginal words: the word “mulu,” meaning “snapper fish.,” or the word “mullu,” meaning red-bellied black snake.”

 

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Making Sense of Autism Spectrum Differences: Books for children

February 28, 2012

by Marilyn J. Monteiro

Parents and professionals frequently ask me about books for children to help explain an autism spectrum or Asperger’s Syndrome diagnosis.

Here are several books that I find to be helpful and accessible to children and their parents:

“Making Sense of Aspergers: A Story for Children” by Debra Ende and illustrated by Bettina Guthridge.

This accessible illustrated book uses the metaphor of different computer operating systems to explain the different perspective and worldview held by children with autism spectrum differences. The positive language used throughout the book encourages the development of a positive narrative about differing worldviews.

To Be Me: Understanding What It’s Like to Have Asperger’s Syndrome by Rebecca Ettlinger and Mark Tomassi

This illustrated guide for children with high-functioning autism is written with sensitivity and clarity. The concept of differences in the way brains work is laid out through the perspective of a 10 year old boy with Asperger’s syndrome.

“What It Is To Be Me: An Asperger Kid Book” by Angela Wine

This illustrated book for children covers the key differences for children with high-functioning autism in an accessible way.

“I  Am Utterly Unique: Celebrating the Strengths of Children with Asperger Syndrome and High-Functioning Autism” by Elaine Marie Larson.

This illustrated book highlights behaviors and qualities shared by children with autism spectrum differences. The author uses each letter of the alphabet to anchor the traits.

“E-mergency!” by Tom Lichtenheld and illustrated by Ezra Fields-Meyer

This delightful book, illustrated by a young man with autism differences, centers around what happens when the letter “E” tumbles down the stairs of the alphabet house and is out of commission. Although it does not directly address autism spectrum differences the illustrations and word play strike a chord with children who appreciate visual details.

“The Curious Incident of the Dog in the Nighttime” by Mark Haddon

This fiction book is narrated by a fifteen-year old with high-functioning autism and provides insight into the sensory-driven perspective of children with autism spectrum differences as the narrator goes on adventures and solves a mystery.

Excellent resources to browse for books covering many autism-related topics include the following websites:

www.autismbookstore.com

www.creativetherapystore.com

www.acerbookshop.com.au

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Master Class with Professor Tony Attwood and Marilyn Monteiro: July 5-6 2012

February 14, 2012

by Marilyn J. Monteiro

 As you may already know, Tony Attwood is a world expert in Asperger’s Syndrome (www.tonyattwood.com.au). He graciously wrote the forward for my book for autism evaluators, Autism Conversations, and has been an enthusiastic supporter of the MIGDAS.

 In July of this year, I will have the opportunity to work with Tony in Brisbane, Australia. The Australian Council for Educational Research (ACER) is sponsoring a two-day Master Class entitled “Autism Conversations: Master Class with Professor Tony Attwood and Marilyn J Monteiro.”

Here is a link to the course description:

http://email.acer.edu.au/t/ViewEmail/r/9C2800B7D575BDDD

 Through an ongoing conversation, Tony and I will be addressing the following topics over the course of the two-day training session: conceptualizing autism spectrum differences, evaluating children and adolescents through conversational interviews, recognizing the unique profile in girls from childhood through adolescence, working with families to promote resiliency, and strategies for promoting positive emotional, social, cognitive and linguistic development in individuals with autism spectrum differences. 

 In addition, ACER is sponsoring one-day trainings with me in Melbourne and Sydney. These one-day workshops will focus on best practice autism evaluation methods and how clinicians can link autism evaluations to practical educational interventions.

 Here is a link to the course descriptions in Melbourne and Sydney:

 http://email.acer.edu.au/t/ViewEmail/r/F232EF602D3E9D20

 ACER distributes many quality educational and evaluation products, including my book and the MIGDAS. This will be my first trip to Australia and I very much look forward to autism conversations with my colleagues in Brisbane, Melbourne and Sydney.

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Asperger’s Syndrome: Over Diagnosed or Misunderstood?

February 2, 2012

by Marilyn J. Monteiro

This week The Opinion Pages in the New York Times ran several articles discussing the misdiagnosis and/or over diagnosis of Asperger’s Syndrome.

In one column, Benjamin Nugent, a man whose mother, a psychologist, gave him the diagnosis when he was a teenager, wrote a thoughtful and insightful article:

http://www.nytimes.com/2012/02/01/opinion/i-had-asperger-syndrome-briefly.html?_r=2&ref=todayspaper

In it, he described being an introverted, creative child who grew up to develop his gift for intuitive social insight. He ends his article with the following comment:

“The definition should be narrowed. I don’t want a kid with mild autism to go untreated. But I don’t want a school psychologist to give a clumsy, lonely teenager a description of his mind that isn’t true.”

As a school psychologist and autism expert, I spend my days interviewing children and adolescents. Over the years I’ve interviewed well over 4,000 children. Benjamin Nugent is correct in his observation that a child can be “nerdy” or “withdraw” or “bookish” and not really have Asperger’s Syndrome or an autism spectrum developmental disorder.

But how do we sort out when a child is struggling with the developmental differences that define individuals who would benefit from a diagnosis of an autism spectrum disorder?

The key lies in developing the ability to have an in-depth conversation with the child or adolescent. Individuals who truly show the differences that merit an autism spectrum diagnosis, including mild Asperger’s Syndrome, organize and structure their conversations in a fundamentally different way than individuals who do not. To get to the heart of this difference, I structure my conversations in a way that is in synch with the unique features of an autism spectrum worldview. I call this having a “neuro-atypical” conversation.

A “neuro-atypical” conversation starts in the middle by jumping into the individual’s topics or areas of interest with little or no social introduction or chitchat. Children on the autism spectrum spend a great deal of time thinking about the facts and details surrounding their areas of interest. The main difference during a “neuro-atypical” conversation about an individual’s areas of interest and a conversation with a “nerdy,” “withdrawn,” or “bookish” individual is that the person with autism spectrum differences relaxes and quickly delves into the details surrounding the topic with little regard for the social nuances of the situation. The “nerdy,” “withdrawn,” or “bookish” person picks up on and responds to subtle social cues during their conversations with others.

Here’s an example of the difference. I recently had diagnostic conversations with two 10 year-old boys. The first boy was deeply interested in Greek Mythology. I started our conversation by asking him if Kronos was considered to be a Titan or an Olympian. He quickly told me the details of the Kronos myth (he is considered to be a Titan; he ate all of his children except Zeus but don’t worry because they didn’t actually die; Kronos coughed them up and they became the Olympic gods) and we had a lively and fun conversation that took us deeper and deeper into details about Greek and Roman mythology and history. This was in the middle of a school day and the boy had never met me before. Even when I asked him if he had any questions for me or for my colleague who was in the room with us, he did not ask any social context or social questions. The experience of having someone display genuine interest in his interests opened the window into seeing his unique worldview. Later in the conversation when I introduced social topics (friends, family) it was apparent that shifting from his agenda to the agenda of social topics was difficult and stressful for him. During the portion of our conversation that focused on his passionate area of interest it was apparent that this child genuinely enjoyed sharing the topic with me. At the same time, there was a sense that part of the pleasure in the conversation was his ability to speak about the topic for his own benefit. In other words, there was a self-directed and somewhat scripted way that he described facts and details. Many times when I offered facts and details he corrected me or overrode my comments and continued with his narrative.

Let’s contrast him with the second 10 year-old boy with whom I also had a diagnostic conversation. This boy’s passion and interest was videogames and specifically Mario Party 8 and Super Smash Brothers. When I started the “neuro-atypical” conversation by jumping into talking about the characters in those games, this child hesitantly and rather reluctantly answered my questions. He looked at me for a long time, looked at my colleague, and told us: “Ooookay…I don’t really talk to grown ups about games. That’s what I do with my friends…” His facial expression clearly communicated that he was wondering where this was going and the purpose of our conversation. When prompted, he asked for clarification, and once the social context was established he relaxed and talked about his social shyness and other personal topics.

Both of these boys struggled with social relationships but only one truly showed the pattern of differences in his developmental that characterizes children with autism spectrum disorders. The child who is passionately interested in mythology struggles socially because he has a desire for social relationships but he literally has difficulty shifting from his agenda to the agenda of others. When he approaches his peers, what is your guess about the prevailing topic of conversation? This child becomes stressed and anxious in social situations because he cannot decode the social cues. His interests capture him in a way that interferes with his ability to use and interpret simple social cues. Furthermore, when he becomes anxious in social situations, his well-developed vocabulary and use of language quickly falters and he has difficulty organizing and using his language skills. He may say unusual things or act in unusual or immature ways.

Receiving a diagnosis of Asperger’s Syndrome can be tremendously beneficial for a child like this. This is especially true if his diagnosis is explained using descriptive language and not the labeling language of the DSM IV. Instead of talking about “restricted repetitive and stereotyped patterns of behavior, interest, or activities,” I talk about how the child organizes his world around his areas of interest, or preferred topics. He organizes his world by categorizing facts and information rather than noticing social and emotional nuances. When he has to manage incoming social, language, and sensory input (unexpected noises, changes in expected routines) he becomes anxious and it becomes increasingly difficult for him to manage his behavior and to communicate. He needs support and direct teaching to help him decode the social world and to expand his ability to recognize and manage his emotional states.

Getting these supports makes a profound difference in a child’s ability to manage the fundamental developmental differences that come with a diagnosis of Asperger’s Syndrome. Most children become less stressed and more confident when their teachers and parents have a coherent way of understanding their needs. That understanding leads to strategies and supports that empower the child. Moreover, it increases the resiliency for children like this child when they read about others with Asperger’s Syndrome. He would most likely identify with accounts written by children with Asperger’s Syndrome. He would find a group of possible friends if he participates in a social skills group at school with other bright children who have autism differences.

Now let’s return to the 10 year-old who likes video games and has some anxiety in social situations but did not show the pattern of differences supporting a diagnosis of Asperger’s Syndrome. If we used the DSM IV labeling language diagnosis, this child showed a “qualitative impairment in social interaction.” In school, he avoided eye gaze, was socially withdrawn, and rarely engaged in reciprocal interactions with others. The reason behind his social interaction difficulties is best understood as some social shyness and anxiety. This child was acutely aware of how marginalized he felt in school with his peers, most of whom organized their social circles around sports activities. He had established a small circle of friends with whom he felt accepted and comfortable. As he grows into adolescence and adulthood and his social possibilities expand to a broader range of people, this boy demonstrated the drive for and social awareness that will help lead him to satisfying social relationships. Would he benefit from supportive counseling to provide him with a place to process his experiences and to talk about his social anxiety? Counseling would most definitely help this child develop the resiliency he will need during adolescence. Describing his worldview through the lens of Asperger’s Syndrome would not only be inaccurate but would only serve to add to his sense of isolation. He would most likely not identify with accounts written by children with Asperger’s Syndrome or by being placed in a social skills group at school with children who have autism differences.

Keep in mind that a great deal of information needs to be considered in making any diagnosis, including a diagnosis of an autism spectrum disorder or Asperger’s Syndrome. Unfortunately, not enough clinicians use the tool of having a genuine conversation with the child or adolescent as part of their evaluation toolkit. Without that connected conversation, school psychologists, psychiatrists, and other clinicians are more likely to misdiagnose. Benjamin Nugent offers the observation that we do not want to over diagnose children. My observation is that we need to get conversational tools into the hands of clinicians so they can do a better job of correctly diagnosing children.

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Videoconferencing in 2012

January 17, 2012

by Marilyn J. Monteiro

As we move into 2012 I wanted to share my plans to provide autism evaluation trainings through my website.

Videoconferencing topics include:

Conceptualizing autism spectrum differences:

Learn how to use a visual framework that is in line with the DSM-V proposed diagnostic criteria to discuss autism spectrum developmental differences in individualized, nuanced terms

The “neuro-atypical” conversation:

Learn how to use the MIGDAS Diagnostic Student Interview to elicit a qualitative behavior sample as you develop the skills to share the unique perspective of children with autism spectrum differences

Interviewing parents and discussing the diagnosis:

Increase your understanding of the parent process when a child
undergoes an evaluation and learn to deliver the diagnosis in compassionate and accessible language

Narrative report writing:

Develop report-writing skills to include narrative descriptions of the child’s behavioral profile and learn to link the individualized profile to practical educational intervention strategies

Differential diagnosis issues:

Learn to distinguish between autism spectrum differences, ADHD, emotional/behavioral disorders, and intellectual disabilities. Learn to recognize conditions that can be co-morbid with an autism spectrum diagnosis.

Last year I met a long term goal of traveling to each of the 20 Education Service Center in Texas to provide statewide autism evaluation team training. This year, instead of traveling around the state, I am providing a 4-day autism team training through videoconferencing. Throughout Texas, 75 sites and over 500 clinicians are participating in this course.

If you are interested in scheduling autism team training through videoconferencing, contact me through my website at communications@marilynmonteiro.com.

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Autism and Infant Mental Health

January 3, 2012

by Marilyn J. Monteiro

This Saturday, I will be providing two workshops at the Infant Mental Health Advocacy Award and Conference in Dallas. The conference is sponsored by the Texas Association for Infant Mental Health (http://mytaimh.org/) and addresses many aspects of the needs of young children and their families.

The first workshop, “Autism Conversations: A Practical Framework for Early Childhood Intervention,” focuses on teaching participants how to recognize and talk about autism spectrum developmental differences in young children.

 Here is one of the issues I will be discussing with the group:

 Describe the Child First and the Diagnosis Will Follow

  • Parents of young children need professionals who…
  • Provide an intuitively understandable framework to understand their child’s puzzling behaviors
  • Use non-technical language
  • Link that understanding to practical strategies

 

Learning to describe instead of label when we observe a child is a cornerstone skill in understanding autism spectrum developmental differences in young children. Describing behavior allows us to see the world from the perspective of the child. I encourage you to get curious about how the child with suspected developmental differences perceives the world. Your careful description of the child’s behaviors will expand your ability to understand the child’s unique experience.

The second workshop, “Autism and Preschool Programming: Engineering the Communication-Centered Classroom,” is a collaboration with my colleague, Judy McCormack Freese. Judy is a speech and language pathologist who coordinates the Preschool Program for Children with Disabilities (PPCD) services for a large urban school district. As a consultant, I work with Judy to support the teachers in preschool classrooms to include key visual supports for young children with autism spectrum differences. In addition to showing clips of teachers discussing their use of visual strategies, we will be targeting five key instructional supports.

One of the five key supports is School-Home Collaboration. The rational and several global strategies to support School-Home Collaboration that I will be sharing with the group are as follows:

 School-home collaboration 

Rationale:  

           Close collaboration between home and school is necessary to…build trust;

           ensure that effective strategies are applied across settings.

   Global strategies:

            Use a notebook communication system between school and home.

            Create a form for the child to use to tell the parent about his or her day…

           “Three things about my day”

            “What I did today”

             “Who I played with today”

              Use photos with simple narrative

             Practice reviewing the sheet with the child at the end of the school day

             Invite parents to use a similar format for he child to share about events at home

             during circle time at school

The five key instructional strategies are discussed in detail in my book, “Autism Conversations.”

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Resources for Parents and Professionals

April 7, 2011

by Marilyn J. Monteiro

 

In conversations with parents of children with high-functioning autism, there are three topics that consistently come up:

          What materials will help my child develop social skills?

          How do I help my child learn to control his or her emotions?

          How do I discuss my child’s diagnosis with him or her?

Attached is a list of resources I’ve found to be helpful in supporting parents in these three areas.

If you find this list useful, let me know.

If there are other resources you’re using, let me know as I am always adding to an updating my resources list.

Monteiroresourceslist[1]

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Sensory Toy of the Week

October 23, 2010

by Marilyn J. Monteiro

     Always on the lookout for novel sensory toys to use in my autism conversations with children, I found this toy several weeks ago in an art museum gift shop: 

Each button activates the cartoon sound effect depicted on the icon. Children who like cartoons love this sensory toy as it provides a bridge in the conversation to talk about their preferred topic.

        I want to share two stories from evaluations last week when children responded to the use of this sensory toy.

        One child acted out each of the cartoon actions as he pushed the 16 buttons. His favorite one was the icon on the second row to the far right. It depicts a circle with arrows to indicate a swirling movement. The sound effect includes chirping birds; the sound that occurs in cartoons when someone is knocked out or hit on the head.

I happened to have several sensory stress balls that have a bird face on them, and a “Pop Up Bob” figure that children like to squeeze to make his eyes and ears pop out:

 This child grabbed the bird stress balls and made them twirl around Pop Up Bob’s head as he activated the corresponding cartoon sound effect. He also held the birds up to his head and moved them around in tune with the sound effect. This recreation of a cartoon routine delighted him and he continued to create this pattern throughout the interview session.

        Another child became fascinated not only with the sounds but also with the visual icons on the toy. His areas of interest included science and physics. As he looked at the icon on the far left in the  third row, he asked “Is that a one ton anvil?” in reference to the number “1” on the very small visual icon of an anvil.

        Toys like these help tease out the sensory entry point for play that is a hallmark characteristic of children on the autism spectrum and distinguishes their play from the play seen in their neuro-typical peers. For the children described above, the toys provided a way for them to create sensory routines. They used these sensory routines to organize their behavior. Shared social interaction was not part of the play as the sensory aspects of the toys captured each child’s fascination in a socially exclusive way. The adults had to enter into the child’s sensory play to attempt social shared play rather than the other way around. This is in contrast to the way in which neuro-typical children use sensory toys as a bridge for social interactions.

        Share your stories about sensory toys you’ve used when evaluating children on the autism spectrum on the Autism Conversations Facebook Fan Page:

http://www.facebook.com/pages/Autism-Conversations/501985855516

        You can find the bird sensory stress balls, Pop Up Bob, and other sensory stress balls at www.officeplayground.com.

        The Cartoon Sound Machine is available on Amazon.

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