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     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:

https://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.

Self-Advocacy for Individuals on the Autism Spectrum

Today I spoke to a group of community college counselors about ways they can support young adults on the autism spectrum who are in the college setting.

Once an individual leaves high school there are two key differences for post-secondary education:

• The burden is on the student to disclose and self-advocate;
• The student must be able to abide by the academic and behavior standards with reasonable accommodations.

 We can help individuals on the autism spectrum become effective self advocates in school and in work settings by helping them identify and discuss key things others need to know to support success in those settings.

I encourage teachers and parents to begin using the simple strategy of developing a list of “Five Things My Teacher Needs to Know About Me” as early as kindergarten for verbal children.

The idea behind this short list is to help the individual identify key strengths and areas of challenge before he or she enters into a new relationship and new school or work setting. The words “autism” or “Asperger’s Syndrome” usually don’t appear on this list of five things because the label itself does not describe individual qualities that are key to the understanding of the child or young adult and his or her needs. Instead, the list highlights the individual’s areas of interest or abilities along with triggers for difficulties.

The list gives the individual a structured way to have an interaction with the teacher or employer that focuses on having the individual self-disclose and ask for assistance. The teacher or employer tend to respond to this succinct discussion in a positive and supportive way.

Here is a sample list from a 16 year old:

1. I love to read and remember facts about many subjects, including science and history.
2. My hobbies include video games and chess.
3. I do best when I know about changes in advance and can see the change in writing.
4. I prefer working alone than in groups
5. Making mistakes frustrates me and I sometimes need to take a break to regroup when I  become overwhelmed

  Notice that the list starts with positive attributes and ends with areas in which the individual may need some help.

If you are a parent of a child on the autism spectrum, or a professional who works with children on the spectrum, consider helping that individual develop a list of “Five Things My Teacher Needs To Know About Me.”

Share your list on the Autism Conversations Facebook Fan Page:

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

        General education teachers are increasingly faced with the need to understand the subtle differences that make up high-functioning autism spectrum differences in the students they teach. Neuro-typical peers also benefit from an increased understanding of and sensitivity to the differences seen in their classmates who have developmental differences on the autism spectrum.

         I recommend sharing the DVD series by Coulter Video (www.coultervideo.com) with teachers as part of their staff development training. The two DVDs I use in training teachers cover the range from teachers in grades 3-6 to teachers of middle and high school students.

         The DVD “Intricate Minds II” is a 16 minute DVD featuring a well spoken and delightful young man with Asperger’s Syndrome as the guide. Several children on the spectrum talk about their worldview and some practical advice is shared. The DVD is suitable for training teachers and educational staff and can be used by teachers to show to their students as well. Because it is intended for teachers of students in the upper elementary grades, teachers need to sensitive in showing the film to their students to protect the privacy of students with autism spectrum disorders who may not yet be aware of their diagnosis. The film is a great way to address differences without specifically focusing on a particular student in a class and can be used as part of a series of sensitivity activities that focus of teaching respect for individual differences.

         The DVD “Intricate Minds” is a 14 minute DVD that targets middle and high school students and has the same young man as the narrator. Teachers who have viewed this have responded positively and expressed benefit from seeing a range of adolescents talking about their experiences. Adolescents who have recently become aware of their diagnosis have also found this DVD to be helpful.

         To help young adults with Asperger’s Syndrome prepare for the transition to post-secondary work and college, I recommend the Coulter Video DVD “Asperger Syndrome: Transition to College and Work.” It is broken into two sections (one on work issues and the second dedicated to college concerns) and covers many practical steps to guide students as they prepare for these important life transitions.

         Next week I will be speaking at a local conference sponsored by two community colleges. In my next post I’ll be sharing some of the content from that talk, entitled “Autism Conversations: Strategies for Working with Post-Secondary Adolescents and Adults.”

Quantifiable and Practical Ways to Assess for High-Functioning Forms of Autism: Part Two of Two

 Recently I was asked to comment on the following question:

 “Is there a common framework for assessing students with milder forms of autism that is quantifiable as well as practical?”

 When a systematic approach is used to gather a detailed behavioral profile, it becomes possible to arrive at a diagnosis that is both quantifiable and practical.

 To obtain a qualitative sample of behavior that is systematic and observable a diagnostic student interview should be completed.

 The MIGDAS* interview process provides guidelines in how to structure a “neuro-atypical” conversation with a student and how to gain detailed background information from parents and teachers. The MIGDAS process helps evaluators coax out nuanced patterns of neuro-atypical development that can be clearly documented and match the experience of parents and teachers.

 To further support the individual behavioral profile gathered through the MIGDAS process, I use the CARS2-HF rating scale**. The CARS2-HF provides quantitatively specific and reliable information to support the qualitative sample of behavior obtained through the MIGDAS interview process. It is completed by the autism evaluation team and the ratings take into account direct interaction with the individual as well as parent and teacher input.

 I also use the SRS*** parent and teacher forms to target social factors and to compare how the individual is viewed socially by parents and teachers.

 The BRIEF**** inventory provides useful information regarding key executive functioning skills.

 Finally, the BASC-2***** provides additional quantifiable information. Many times the Atypicality scale is elevated for individuals with mild, high-functioning forms of autism.

 *MIGDAS: Monteiro Interview Guidelines for Diagnosing Asperger’s Syndrome: A Team-Based Approach (www.wpspublish.com)

**CARS2-HF: Childhood Autism Rating Scale, Second Edition-High-Functioning Version (www.wpspublish.com)

***SRS: Social Responsiveness Scale (www.wps.publish.com)

****BRIEF: Behavior Rating Inventory of Executive Function (www.mhs.com)

*****BASC-2: Behavior Assessment System for Children, Second Edition (www.pearsonassessments.com)

 What autism behavior checklists do you like to use? Visit me on facebook at “Autism Conversations” and join the conversation!

Recently I was asked to comment on the following question:

“Is there a common framework for assessing students with milder forms of autism that is quantifiable as well as practical?”

Increasingly, psychologists and other evaluators are asked to assess children for milder, high-functioning forms of autism. The children in question are typically in general education classes and do not have cognitive delays. They may have been identified as having a form of Attention Deficit Disorder, or an emotional disorder such as anxiety, depression, or obsessive-compulsive behavior patterns.

Because these individuals are on the milder end of the spectrum they do not show evidence of their differences in all settings. Many times the differences are subtle in their presentation and do not stand out during formal testing situations, including during the administration of Module 3 of the ADOS.

To reliably assess for high functioning forms of autism—Asperger’s Syndrome, high-functioning Autistic Disorder, and verbal children with Pervasive Developmental Disorder-Not Otherwise Specified—it is critical to include both quantitative and qualitative measures.

 A common framework question you are asking when you complete an evaluation for suspected high-functioning autism spectrum disorders is as follows:

 What is the most compelling way to understand and describe the individual’s pattern of differences in development?

The three areas of development in question are:

 Language and Communication

Social Relationships and Emotional Responses

Sensory Use and Interests

Here is a quick reference chart to help distinguish between individuals with various high-functioning forms of autism: Asperger’s Syndrome, Autistic Disorder, and Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS).

AutismConversationsQuickReferenceChart[1]

Questions and answers about the conversational approach

I love having conversations with individuals on the autism spectrum because each conversation provides a dynamic entry point into understanding the child’s sensory-driven perspective on the world.

These “autism conversations” help me talk with parents and teachers about the child’s worldview in understandable and compelling terms. It becomes readily apparent how understanding the child’s unique view of the world can serve as a bridge to teaching that child communication and social skills that are more challenging areas of development for that child.

Children love participating in the conversational approach because instead of being redirected away from the toys and topics they are passionate about, they are able to share their passions with others.

If we invite children to share their areas of interest with us, those children show us the entry point for teaching them to manage the social and language demands they face in their daily lives.

Last March I was interviewed by Michael Margolis as part of a live telecall. The interview provided an opportunity to talk about my approach to evaluating individuals on the autism spectrum; something I am passionate about. I invite you to read the transcript to learn more about the conversational approach.

You can also go to www.autismconversations.com to listen to the interview.

Be sure to visit me on facebook. Just type “Autism Conversations” into your facebook search and join the conversation!

Categories: autism conversations; media; autism evaluation methods

Tags: autism conversations transcript; conversational approach

 Early Intervention and Autism Diagnosis

Here is a recent question I received about how to talk about autism with parents of young children and my response.

 “Dear Marilyn,

 As an Early Interventionist I find that I am frequently working with parents who may themselves be on the spectrum.  Sometimes they don’t see their child’s behaviors as a problem because they were the same way as children. Do you have some strategies that would help?”

  Recently I did a home visit autism screening with an Early Interventionist because the mother was concerned after both the Interventionist and the child’s pediatrician mentioned autism. The mother told us she was just like her son as a child and continues to be comforted by routines and rituals. As she researched autism on the internet she became alarmed and anxious because her experience was twofold. She was recognizing behavior patterns in her son but in herself as well.

A strategy that is helpful and empowering for parents is when Early Interventionists focus on using descriptive language instead of labels. Autism is such a daunting word, and especially for parents of young children, it is often associated with anxiety and dread.

 When you spend time carefully observing and interacting with the child using the sensory entry point to gain the child’s perspective on the world, you can empower that parent to better understand their child’s differences. You can start an ongoing conversation about strategies and interventions in an accessible way that is not always available when the conversation centers on the diagnosis and the clinical words associated with a diagnosis of autism.

 With the parent I just talked about, I spent time watching her son and then connecting with him through the shared enjoyment of sensory objects—in his case, sensory stress balls and inset shape puzzles—before the topic of autism was broached.

 Before we talked about autism we talked about how her son sees the world and how best to form a connection with him. She was able to watch her son relate well to a new person and to recognize that the connection occurred because the child’s worldview was being understood.

 The mother made important connections about how the strategies she was using to help her son make communication and social strides were working precisely because she was naturally following her understanding of her son’s differences in development.

 For example, she noticed that he studied the details of pictures and began using pictures as a way to prepare her son for transition times. We were able to talk about how the pictures helped her son better anticipate transition times, making them less stressful. She noticed that he responded better and was less prone to tantrums and agitation when she used visual prompts along with talking to him.

 This discussion led to her understanding that her son’s organizing principle was visual rather than based on the use of oral language or social cues.

 Talking about how a young child is showing differences in development in the three key areas of language and communication, social relationships and emotional responses, and sensory use and interests provides a framework for parents to think about and understand their child.

 I talk with parents of young children about their child’s differences in each of the three key areas and gain consensus on their perspective before I bring up the “autism” word. By talking about differences in development, we can discuss the child’s areas of strength and abilities as well as the areas in which the differences are linked to areas of difficulties such as social language and social play.

 This discussion, accompanied by my drawing the descriptive triangle of differences in development (see Chapter 6 in my book Autism Conversations for more information on the use of the descriptive triangle in sharing the diagnosis with parents), provides a natural opportunity for the parent to talk about connections they make about themselves and their worldview.

 The use of this approach to talking about autism spectrum disorders shifts the dialogue from being about identifying problems to identifying differences. This shift is profoundly important in helping parents go through the process of understanding and dealing with an autism spectrum disorder diagnosis.

 The word itself—autism—becomes far less daunting when the focus of the conversation is on the child’s nuanced behavioral profile instead of the label.

 If parents tell me they see the pattern of differences in themselves, then I talk about how that will help them be more in tune with their child’s needs. I also emphasize how the understanding of the child’s differences in development helps us form a bridge using the child’s natural strengths to help develop skills in the areas that are more challenging for him or her. Remember to focus on listening to the parent rather than diagnosing the parent.

 Parents may ask you for resources to read more about autism spectrum disorders. Websites such as www.autism-society.org and www.autismspeaks.org are good places to start.

In July I was invited to be a guest on the Dr. Pat VoiceAmerica radio interview program to discuss “Autism Conversations.” Dr. Pat was a delightful host who asked insightful questions. Her enthusiasm for the main theme in the book—understanding and describing the unique qualities of individuals on the autism spectrum—was apparent throughout the program.

My thanks to Dr. Pat for getting the word out about the conversational approach to a broader audience!

Back to School

It’s that time of year again… teachers are back in the classroom; parents are getting their children ready for the school routine; and special education staff are providing support to parents and teachers alike.

As you start the new school year take a few minutes to watch and appreciate the unique worldview of the children you work with who have autism spectrum developmental differences. Get curious about the areas of passion and interest that delight and motivate the individuals on the spectrum that are part of your daily life. Then find a way to link that passion with the skills you are trying to help that child acquire. More often than not, you’ll find that the child is seeking out visual patterns and routines.

Today I helped a teacher of a kindergarten boy do just that. She was feeling overwhelmed by the task of trying to get him to follow her agenda—he wanted to spend the day using the computer and specifically using programs that taught letters and words. His passion is the alphabet. We put together a visual schedule for him that allows him to follow a trail of alphabet letters throughout the day—with each letter linked to a classroom activity. Pairing his passion with a visual schedule gave him the organizational tool he needed to help him successfully shift from his agenda to the agenda of the teacher.

Visit this website to see some visual teaching supports developed by teachers for children on the spectrum: www.oneplaceforspecialneeds.com.

Have a great start to the year, and check back here next week for more musings and suggestions.

The Words We Use Make a Difference

 “He does what I ask him to do when he wants to.”

“He knows what to do but chooses not to.”

“He’s uncooperative.”

What do those statements have in common?

They make an assumption that the individual in question is making a willful choice. How does that assumption help describe what’s really behind that pattern of seemingly uncooperative behavior?

 The truth is, we don’t know by watching a person whether our assumptions about his motivations are accurate or not.

 The words we use make a difference in how we interpret behavior.

 Maybe the child fails to respond to our directions consistently because we are not taking into consideration that child’s need to shift his focus from his internal agenda to the agenda of others.

 I interviewed a nine year old recently who was passionate about fossils. He told me that many fossils are amazing; especially bivalve fossils from the Cambrian period that can be found embedded in rocks.

 His teacher reported that he only does what she tells him to do “when he wants to.” She is frustrated because when she asks him what he is supposed to be doing he tells her the correct answer. So she makes the assumption that he is uncooperative and chooses not to.

 The behavior management choices for this line of thinking usually focus on establishing consequences instead of engineering the environment to provide visually predictable signals.

 When we evaluate children for suspected forms of autism, part of the job is to use descriptive language that helps teachers and parents understand why the child behaves in difficult ways.

 Going back to the budding Paleontologist, once I learned the extent to which he was captured by his internal world, I was able to talk with the teacher about how much effort it takes this child to stay connected with the flow of events in the classroom.

 The teacher’s response was to visibly become energized, in contrast to her rather discouraged posture when she was describing her frustration about the child’s lack of cooperation.

 She made an important connection: the child was most responsive when she stood close to him before speaking and when she could point to written instructions to back up her verbal request. She made the comment: “Even though he knows what to do he does better when he can literally look at the request.”

 The reframing of the child’s behavior into descriptive language shifted the conversation to a productive dialogue.

 In your discussions with teachers, and with your colleagues as you evaluate children, listen carefully to the language you use. The words you use truly make a difference in how you interpret behavior.

 Listen to the children’s interests when you talk with them and then tell their stories. It can make all the difference in the way people view them and the interventions they use to support them.