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Autism Spectrum Explained
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  • Home
  • Introduction to Autism
    • Characteristics
    • Common Myths >
      • Negative Narrative >
        • Autism Controversies
  • How to Interact
    • Stigma & Discrimination
    • What to Avoid
  • Advice for Parents
    • Visual Supports
    • Autism Treatments
    • Explaining Autism to Kids
    • A Mother's Story
    • My Sibling Perspective
    • Autism Explained for Kids Site
  • All Kinds of Minds
    • Culture of Autism
    • Late Diagnosis
  • More
    • How to Assess Claims
    • What Causes Autism?
    • Additional Resources
    • Site Info & Feedback >
      • About the Website
      • ASE FAQ
      • Survey
      • Contact Us
      • Make a Submission
  • Our Blog
    • On Self-Advocacy
    • Trouble with Changes
    • Smoothing Transitions
    • Autism Speaks
    • Vaccines
    • Infantilization
    • Her Autism is Worsening
    • Stimming
  • Autism Tutoring

Supports for people on the spectrum are also Supports for Caregivers

12/14/2015

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In typical me fashion, I was sitting up late last night thinking about autism, pondering over the supports we use for people on the spectrum - sticker charts, visual schedules, etc. And then it occurred to me. These are as much tools to train caregivers to interact and understand someone on the spectrum as they are tools for the intended person.
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I thought about each support one by one, and here I'm going to take you through how they can actually help caregivers as much as caregivees...

1. Sticker charts
These have been much decried in recent years as tools for people on the spectrum, due to concerns about extrinsic vs intrinsic motivation, among others. But one thing these do that we don't think about is they remind caregivers to look for positive things to reward.

Having that sticker chart is a reminder to look for the great things a child on the spectrum does, when the most salient things for caregivers of children (either on the spectrum or off) tend to be the bad. So I love the idea of using a sticker chart for the caregiver, to remind US to give praise throughout the day.

2. Visual schedules
Predictability is SO important for reducing anxiety in a person on the spectrum. And yet, our world doesn't tend to provide that. A visual schedule is a great way of not only giving a person on the spectrum a way to see what's happening next, but it's also a great way for us as caregivers to be held to that schedule.

When you don't have a schedule written down and given to the person on the spectrum, you are liable to deviate quite a bit without warning. If you have a visual schedule, it's a reminder that you need to change that schedule (and thereby give a warning to the person on the spectrum of the change) before you change your plans.

3. Timers
Similar to a visual schedule, a timer holds both the person on the spectrum AND the caregiver to a commitment in terms of the routine and transitions.

4. The 5-point scale
The five point scale is a way of communicating a state of emotional regulation. A 1, for instance, is fully regulated, whereas a 5 is extremely unregulated.

Right after I learned about this scale, Caley called me in the middle of a panic attack. Wanting to apply what I'd learned, I explained the five point scale and asked where she fell. She said she fell at a four, and defined a four as feeling "like I want to run in the closet and hide".

Yes, the scale was intended to support Caley, but it was a tool for me as her ally to remind me to ask her how she's feeling, and then better understand how that felt to her. I had no idea before that a "4" felt THAT bad to her. This tool, too, went two ways.
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5. Functional behavior analysis
This is a tool held up as the foundation of changing a child's behavior. Essentially you figure out what happened first, what happened next, and what function that behavior served.

Yet, it can be used as an far better tool for ourselves. It's a constant reminder that behavior is communication. If a child screams and then the adult interacting with them goes away and they stop screaming, they might be saying "I'm overwhelmed." Biting might be a way of saying "pay attention to me". These analyses teach us to look for the underlying meaning in behaviors, rather than just brushing them off.

These are just some examples of the ways that these supports run both ways, but there are many more. What tools can you think of that run both ways?

-Creigh
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The Kindle Fire as an AAC Communication Device

11/27/2015

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Picture
One of the things that I have always appreciated about the Kindle Fire (which I am not affiliated with, but do, in fact, own) is that it's a very low cost access point for a communication device. It's only $50.
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Quick Talk AAC, Speech Assistant AAC, LetMeTalk, TalkinPictures, TalkTablet, Gabby Tabs - you may not have heard of them, but these are all communication apps available for Kindle devices, most of which are FREE.
​

That means that, for the low price of $50, you can try out several AAC (Augmentative and Alternative Communication) apps for your child or yourself. What's more, there's now a way to unlock the Google Play store without rooting your Kindle, so that ANY AAC app available for Android will be able to work on your Kindle.

I don't know about you, but I think that's amazing. If you already have a communication device for your child, but want a more mobile one, or one you don't have to worry so much about breaking during high use situations (it's $50, so less stress), this is a GREAT addition.

What's more, devices can actually be really great for working on turn taking, visual schedules, and even spoken communication. I know when I nannied a child on the spectrum, one of the BEST communication activities I could do was watch Angry Birds videos with him on his iPad. I would ask him wh- questions about what was going on, he would also ask me questions about the characters, I would work with him on making inferences about what was going to happen next...the list goes on.

What matters is not so much the device itself, but what you do with it. And with a Kindle Fire you can do a LOT.
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You can purchase one here:
http://www.amazon.com/…/B…/ref=s9_acsd_bw_dcd_odsbncat_c0_t…

And check out the AAC apps that come with the Kindle Fire store here: http://www.amazon.com/s/ref=nb_sb_noss…

And, if you'd prefer to use the AAC apps in the Google Play store (which are more varied than those in the Amazon store - top ones include Alexicom, Avaz, JABtalk, Sono Flex, Nova Chat, and more!), you can add the Google Play store to your device without rooting it by following the directions here:
http://www.geek.com/…/you-can-access-google-play-on-amazon…/

Have concerns about using a communication device with your child? Check out this article about them 
http://www.speakforyourself.org/…/myth-augmentative-altern…/

-Creigh
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On Toothbrushing, Sensory Sensitivities, and Pain

10/30/2015

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As those of you who are caregivers for those who have sensory sensitivities (as most anyone on the spectrum does) or who have these sensitivities yourself know, toothbrushing can be a sensory NIGHTMARE! I'll let Caley explain how it feels:

"PAIN!"

That's all she said when I asked her to describe it and I think that's plenty. And flossing, she says, is even worse!

When she was younger, our parents were in charge and made sure her oral hygiene was kept up by making her brush her teeth.

However, now that she's an adult who can make her own decisions, Caley has declared that the pain of toothbrushing is not worth the benefits (which should tell you just how painful it is) and that we should try to find something to do instead.

Here's everything we've tried so far, including what's worked and what hasn't, so that those of you with similar difficulties can learn from our experimentation.

Attempt #1: No Burn Mouthwash
Caley vetoed regular mouthwash right away, for sensory reasons, but agreed to try "no burn" mouthwash instead. Apparently that's false advertising on their part because she took one mouthful and immediately had to spit out and rinse.

As Caley says "It BURNED!!!!! It was lies!"

As that didn't work, we tried a mouthwash that didn't have any alcohol in it whatsoever: Biotene mouthwash. Caley approved of the lack of the burn, so this product gets the thumbs up from her!
That said, mouthwash alone is no substitute for an actual toothbrush. So we kept looking...

Attempt #2: Water pic
We thought this might be able to help with actual plaque removal, unlike the mouthwash. At the same time, unlike toothbrushing the water didn't have painful bristles, which was a point in its favor.

Unfortunately, despite looking like a good product for sensory avoiders this didn't work out. Not only was the water pressure not enough to really get rid of all the plaque, but the machine itself was LOUD, which set off sensory sensitivities in a different way!

Points for effort, but this one ended up being a waste of money for her needs.

Attempt #3: Stimudent
These are little wooden picks that you use to get plaque off your teeth. These, unfortunately, didn't work out either, also for sensory reasons, as well as practical reasons.

Sensory wise, they made Caley's gums bleed. The taste of blood really bothers her, so that was already enough to make her not want to use them. On top of that, it takes a forever, in Caley's words, to fully clean your teeth with these. Practically, therefore, these didn't pan out either.

Attempt #4: Trident gum
This one met with approval! Trident gum helps (slightly) to mechanically dislodge food in the mouth, and an ingredient in it, xylitol, helps make the mouth a less pleasant environment for harmful bacteria. That's actually the same ingredient as they use in baby toothpaste!

​Again, like mouthwash, definitely not a replacement, but certainly helpful as part of a bigger oral hygiene plan.

Attempt #5: Oral swabs
These are basically little sponges attached to popsicle sticks. You can get them plain or, as we did, treated. Ours has dentrifice on it, which acts to scrub plaque away by abrasion, as toothpaste does.

They're easy to use, you just brush them around your mouth like a toothbrush. They're meant for people with disorders or health problems that make toothbrushing impossible - which certainly applied!

Caley tried them and deemed them a success! Not only did the sponge not cause pain, but it was also pretty much flavorless (despite saying they were mint flavored) - another point in favor for a sensory avoider!

We had a winner!

Conclusion:
Now, am I saying these solutions are as good as flossing and brushing? No, not by any means. However, they mean Caley doesn't have to be in pain anymore, and using all three of them together (Biotene mouthwash, trident gum, and the oral swabs) makes a halfway decent oral care program.

It was definitely worth it to respect Caley's needs and find something new instead of trying to force her to do something that wasn't working for her. Caley and I are sharing this story to help those of you with similar needs find something that works for you, too!

Let us know in the comments about any other sensory friendly oral hygiene products you know of, or if you've run into similar toothbrushing issues yourself!
​
-Creigh
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Idea for Head Banging

9/27/2015

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Picture is of a black mesh back support
So a while back I was working with a child on the spectrum who liked to bang his head, which is pretty common. It's generally a sensory seeking behavior...but it's pretty bad for your head!

I happened to have one of these mesh back supports in my car and on an instinct attached it to the head of the chair the child was banging his head on. He LOVED it! He was able to still move his head back and forth and meet resistance when he went back, without actually banging his head on something.

Since it's mesh and elastic, the material gives quite a bit, which protected his head as he banged it and made sure he never actually made contact with the chair itself. The nice thing is, they're also super inexpensive - you can get them off of Amazon for less than $5.http://www.amazon.com/Fellowes-Office-Suites-S…/…/B000MUSOZ6 (I'm not affiliated, just providing a link.)

Let me know what you guys think! As always, I'm not a professional, just writing from personal experience - it went well for this boy and I thought I'd share the idea with the rest of you! 

-Creigh
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Communication Placemat

9/15/2015

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Photo of a hand-drawn communication placemat. Silverware and plates are drawn in the center, surrounded by handwritten messages on the edge of the paper, such as
In my AAC (Augmentative and Alternative Communication) class today my professor mentioned a great idea - communication placemats for meal time! She said she'd used one at a pre-school she'd been at before, where communication placemats were made. She said they distributed them to all the children, speaking and non-speaking alike, both for normalization and so the speaking children could model how to use them for the non-speaking children.

I made mine with a camp I helped out for elementary school students in mind - I put meal related things on top, social-related on the right, and adult related on the left. But this would be great to adapt to your own personal needs, too! You can use picture symbols instead of words for non-readers and use vocabulary more common at home. If I had to go back, I'd add in "like", "dislike", "I", and "want" that way you can prompt for sentence production (ie the child can point to "I want food").
​

Let me know what you would do to yours! You can buy them online but I literally drew this one in five minutes in class and all you'd need to do is laminate it.
​
-Creigh
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A Story of Dysgraphia, Anxiety, and A Middle School Project

8/7/2015

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When we were in middle school, Caley and I were both required to draw maps. I mean, free hand draw a map of an entire continent, or a topographic map of Southeast Asia.

Caley and I got to talking about those maps this morning, and she revealed to me that at points she'd been thinking about breaking her arm so she wouldn't have to draw them. She was a MIDDLE SCHOOLER thinking about BREAKING HER OWN ARM.

And my family and I had no idea.
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Sure, we knew that as someone with dysgraphia (common in people on the spectrum) writing hurt her - but we never realized it hurt her THAT much. And, yes, I personally knew how anxiety inducing those maps could be for those of a perfectionistic bend - I remember how painstakingly I drew the fjords of Norway and despaired over getting Crimea just right.

But I didn't know. I didn't realize just how bad it was for her.
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I'll let Caley tell you the story in her own words:

"They were free hand-drawn maps. We'd do things like the 13 colonies, Europe and Australia. Europe was the worst. You had to draw the coastline and then map within five miles the different cities. And you had to color it in and make it pretty and it did matter how it looked. That's one of the few C's I got in middle school.
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It hurt a lot because of my dysgraphia and then it extremely stressed me. I remember hurting myself throwing my pencil up in the air in frustration. The first map I didn't think of it. The second and third maps I definitely thought about breaking my own arm. Because it HURT to write that map. And it was SO stressful. I don't think my meds were really good back then so, along with going through puberty, everything just combined together.
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I don't know how to describe it, it just hurts to write. I can do a little bit, but because of the way I have to bend my fingers so that I can have any kind of fine motor control over the pencil it becomes REALLY painful.

I don't think I ever told [other people] it hurt. Although it should have been fairly obvious by how I acted. I often shook my hand out, although that looked like stimming, and I hated writing. Typing was a lot better.
​
I think they did the maps to attract those into art into learning, but it kind of was punishing to everyone who didn't."

I don't know if there's one single lesson to this story.

Maybe how painful dysgraphia can be?

Or how bad anxiety can get?

The importance of teaching self-advocacy?

Or the way that these moments of anxiety can just go under the radar, because we don't realize JUST HOW BAD it is for the person?

​The need for accommodations?

​The way an assignment can be so frustrating that a child is thinking about hurting themselves to get out of it?

In the end, I think this story tells all of those and more.

​-Creigh
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Miss Creigh is Moving

8/5/2014

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I spent the morning making a story that I never wanted to read - the one explaining that I'm leaving the child I care for. I'd tried explaining last week, saying that Miss Creigh was moving away to a 'far away land' (I tried to keep it fun), but - perhaps because of the abstraction - it wasn't clicking for him. So I made it visual, in a social story.

I spent hours working on this thing. Finding the exact right pictures to use. Making sure that he knew I loved him, even though I was leaving. Piecing together a picture of the map, including where the child lives and where I'm moving to, to make the abstract more concrete. Figuring out a coping mechanism to incorporate into the book that he could use if he missed me too much. (Looking at a picture of me and calling me.) 

But despite all that work, when it was finally done I was scared to read it to him. What if he got upset? What if it wasn't the right time to say? I was extremely worried about it, to say the least. 

Ultimately, though, I felt I couldn't put it off much longer, and, using the iPad as a bribe, got him to sit down with me and read the story.

Not only did he not react badly, which is what I was so, SO afraid of, he actually LIKED the story! I'd incorporated lots of cool pictures of us doing fun things together (in the introductory part of the book), and he loved going over them as I asked him questions to keep it interactive. (Q: "What are you pretending to be in this picture?" A: "A ghost!" Or, my favorite part, as I read the page with "Miss Creigh loves you!" he responded, "Love you!")

And he UNDERSTOOD. After we were done reading, I asked him some questions to ensure comprehension.

Q: "What's Miss Creigh doing?"
A: "New house!"

Q: "Is Miss Creigh's new house close or far away?"
A: "Far!"

Q: "Who is going to be your new nanny now?"
A: "That one!" [Pointing to the new nanny who was standing next to us.]

Q: "Is Miss Creigh going to visit?"
A: "Yes!"

He got it, you guys. I'll keep going over the story to ensure comprehension, and the new nanny and parents know where the book is, but HE GOT IT. Another reminder that we don't give kids on the spectrum the credit for understanding things that they deserve. And, whether because he actually did understand last week when I told him and just needed time to process, or because we'd already started transitioning in the new nanny who he loves, or the comfort of the story or whatever reason, he was okay with it.

This is better than my wildest dreams, you guys. I am so INCREDIBLY relieved right now. Leaving will still be hard, intensely so. But this makes it so much better.

-Creigh
Picture
Photo is of the first page of the story, appropriately titled "Miss Creigh is Moving." On it is a clipart picture of a little red Volkswagen towing a huge rolling box of belongings. It couldn't look any more unrealistic or different from my actual move - which required a U-Haul - if it tried, but hey, whatever works...
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Autism and Haircuts Part Two; The Lego Trim

7/29/2014

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I wanted to share with you all two words I never thought I'd hear.

"Please snip!"

Yes, you read that right! We did trim take two today and as you can tell, it went really well, beyond my wildest expectations. He was ACTUALLY REQUESTING THE CUTTING by the end! I cannot tell you how exciting that is, but I think you know. 

So, here's the part where you wonder, what did we change that made us getsuch a different result this time? For one thing, we minimized the sensory load where we could. We did the trim inside the hairdresser's house, which really took a lot of the environment stress away. We also blew the hair off of him immediately when it fell, and tried to keep it from falling on him in the first place. And we did it in three snip bursts, counting them to make sure he knew how long he had to put up with it each time (which seemed to really help). We also didn't make him wear the hairdresser cape when he refused (and, for the first time, he explained why - it's too tight around his neck).

The real keys to success, however, were these: listening and rewarding. The hairdresser said the scissors were taking too long, and she wanted to use the clippers. Well, behavior is communication, and it was DEFINITELY communicated that those clippers were allowed nowhere near his head. (And continued to be communicated for ten loud minutes, until I convinced the hairdresser to heed him and go back to scissors.) Had we kept trying for the clippers, we would not have had a successful haircut. The hairdresser said, he just needs to see that the clippers don't hurt. But we need to trust that he knows himself and his needs and actually listen - and once we did we got the outcome we wanted. 

The other key was the reward. Normally, I brought candy and would give him M&Ms in exchange for snips. It occurred to me, though, that Legos are much stronger reinforcers for him (like many kids, he's super into Legos), and so before I came I bought a Lego Juniors Spiderman set. Best. Idea. Ever. I opened it up and showed him the pieces, and explained the deal. Every time he did three snips, which we counted together, he'd get one Lego to add on to the figure (going in the order of the instruction book, of course). 

It worked AMAZINGLY. At the end, I was showing him the next Lego he needed ("Oh, you have three tires already, but you need one more!") and before I could remind him that he had to do 3 snips to get it he was on top of it! "Snip, please!" he said calmly each time (by the end), and actually held still! No screams, no fighting, heck, hardly even any fidgeting! It was awesome. By the end, we had a happy boy, a fully assembled Spiderman set, and the best haircut I've ever seen him have. Oh, and a very, VERY happy nanny! 

We had to get creative, yes, but after months of trial and error I think we've finally found the magic formula to a stress free haircut!

-Creigh
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Autism and Haircuts

7/25/2014

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We're doing another haircut tomorrow you guys. And right now, as I'm trying to go back to sleep, I can't help asking myself over and over in my head - is there anything else I can do to make this easier? And, more importantly, do we have everything prepared? As we've done several of these haircuts now, I'm starting to develop a list of things that we need to bring to make the process go more smoothly/easier on him. At this point, it's almost like a checklist.

My Checklist for a Successful Haircut
- Phone with lots of fun apps
- iPad, also with lots of games
- Super hero capes (he won't wear the hair dresser capes, hence the super hero capes)
- Lots of choices of clothes: Long sleeve shirts and long pants (multiple sets to change out as hair gets on them) and Buzz lightyear costume (because may as well try to make this feel cool)
- Visual schedule (with a positive thing, going out for ice cream, immediately after the trim)
- Candy (I use candy as reinforcers. My candy of choice is mini M&Ms to try to reduce the quantity of sugar getting into him)
- Sensory brush (for before the appointment)

And the most important thing? A hairdresser trained in working with autistic people. We have an autism group semi-locally and I called to ask them who they recommend (which I highly recommend parents do as well!). Turns out they train businesses to be autism friendly and they recommended this one. It also turns out that this particular hairdresser didn't need all that much training - her son is autistic. This will be our first haircut with her, but I'm sure she'll be great.

Now, some of you may be wondering, why is having a haircut such a big deal? There are three major aspects to this answer:

1. Sensory issues
This is a really big factor. Hair salons are often bright, you have loud clippers/scissors on your head/next to your ears (I'm bringing ear plugs to help with this, if he'll wear them), and, worst of all, some stray hair will inevitably fall on your skin. For those of us without sensory issues, this hair is already annoying and bothersome. For someone WITH sensory issues (which autistic people do have) this is likely to be magnified, to the point of a significant amount of pain. Either different sensory issues (maybe the velcro?) or simply past bad experiences have led the child I care for to refuse to wear a hair dresser's cape. That means in order to keep the hair from falling on his skin (which hurts), we've had to get creative - hence, the super hero costumes.

2. Bad experiences
Even the hairdresser herself said before she knew her son was autistic, she didn't know how to help him with haircuts. Before a child is diagnosed, it can seem like they're just having a temper tantrum or 'acting out'. And even if you know those aren't the case, without the guidance of a diagnosis it can be hard to know what to do to make haircuts less traumatic. This can result in bad experiences for the child and lead them to associate hair cuts with bad memories. Parents, don't feel bad - before a diagnosis, you really can't know why children are reacting this way, and if you don't know, you can't know how to help.

To help with the previous bad experiences, at a previous hairdresser's brilliant suggestion, we've rebranded hair cuts. They are no longer called hair cuts around him, they're called trims. This actually works because the experience that we're doing now is like night and day different from what happened before he was diagnosed. Now we play by his rules on his schedule, to whatever extent we can, and offer loads of treats and games to help smooth the experience. And when I told him we were going to be doing this tomorrow, he made sure to tell me that it was NOT allowed to be a hair cut, it had to be a trim. So the rebranding has definitely worked.

3. Change
Change can be a difficult and scary thing to deal with for people on the autism spectrum, and hair cuts bring change. They bring change in how your hair looks, and they can also bring changes to established routines. To help minimize the impact of the latter, we're using a visual schedule (which we started reviewing together this past night). 

We're also making sure that this is coming on a day relatively free of change earlier in the day. Last time I made a mistake in assuming since a change earlier in the day had been dealt with well, we were still fine to deal with the trim. I was wrong. Dealing with change and sensory problems and other issues isn't just something that gets taken bit by bit. It's a cumulative effect. So though he'd done well with the change earlier in the day, that left him with less energy left over for coping for our big change in the afternoon.

So that should hopefully help explain the reason that haircuts can be so difficult, and what we're doing to help minimize these issues. Oh, you guys, I am so nervous for him (as I always am with these haircuts - I know how rough they are on him). I really, really hope it goes well and we can continue down our road to successful, non-traumatic hair cuts. *crosses fingers* Wish us luck!

-Creigh



Update: It did not go well, and so we decided to try the cut again a different day in a different location (in the hairdresser's home instead of in the salon - even when you think you have everything covered, there's always one variable you fail to account for and that was it...). 
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Transition Time!

5/15/2014

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Today I wanted to take the time to introduce you all to something Caley and I have both found to be beneficial, from our respective positions as an Autistic person and as a caregiver for a child on the spectrum: transition time. 

What's the big deal with this? Well, to those of you who aren't aware, people on the autism spectrum frequently have trouble transitioning from one activity to another. This can be due to many factors, although need for predictability (change is scary!) and a warning about an impending shift in the sensory environment seem to be the biggest. Transition time can be accomplished by many means, but all of them work towards the same end - warning that a transition is upcoming.

The benefits:
Growing up, Caley says that transition time was really helpful for her (and our mother says it made her life easier, too!). Given their backing, I started implementing it with the children on the spectrum I care for and saw pretty immediate improvements in the behavior of the children I care for (a huge decrease in crying/screaming/upset incidents and an actual decrease in the time it took me to move us to the next activity) myself.

How to help:
If you read about a lot of the products out there, they make it seem like you have to either spend money on a gadget or time with arts and crafts to create something to help you work through transition time. What works for each person is different, but the tools I use are completely free (given you have a pen and something approximating paper), take a matter of seconds to do, and I have found to be very effective.

Here's the first one: Visual Schedules
Picture
As you can tell from these schedules, they don't have to be pretty. These are all after school schedules that I drew on the fly. The largest one, in the background, depicts our schedule: 1) Therapy, 2) Home, 3) Grandparent's house, and 4) Home (again). The smaller schedule in the upper right is 1) McDonald's, 2) Home, 3) Play iPad, 4) Pick up big brother at school, and 5) Go visit the grandparents. And the last one, in the lower right, is 1) Go to the grocery store and buy a dog bone, 2) Go to therapy, and 3) Go home.

If I know that there's something we have to do during the day that one of the children I'm caring for doesn't want to do, or simply want to reduce anxiety around the day's events, I'll make a visual schedule. 

If you want to go all out with this, you can buy the tools for them online, but for me I've been able to get by simply scribbling down stick figure approximations on whatever paper-like substance I find. Sometimes this is actual pieces of paper, but more often than not it's bits of envelopes (as in the one on the lower right) or napkins. How pretty it looks doesn't matter for the effects, as long as the person can associate what you've drawn with the event, so even if you're not an artist, don't worry - as my drawings show, you don't have to be great at drawing to make this work.

I've actually found that this allows for a degree of flexibility, too. You'll note that one of the schedules has a lot of scribbled out events (upper right). That's because it changed as we went. Since the child who used that particular schedule had a GREAT day at school and asked very politely, I agreed to take him to McDonald's before we went home, so I squeezed it in. By popular request, I also added iPad time into the schedule.

Due to the insertion of McDonald's into our plans, though, I no longer had time to go fill up with gas (thankfully I had enough to cover me, if only just), so I scribbled out my previous crude drawing of a gas pump. Later in the day I got a phone call of a last minute change in plans which meant we'd be going to visit the grandparents instead of going home. 

Those of you who know people on the spectrum or are on the spectrum know that last minute plan changes are pretty much the most difficult kind to deal with. Having promised that we'd be going home, I was concerned I'd have an upset child on my hands. But I frantically scribbled out the picture of home and added in a picture of the grandparent's house (with all of us in front), and the results were like magic. I got only one, calmly phrased, question about it and that was it. The transition was great, but without the visual schedule there's no way it would have gone that smoothly.

The second thing I do to help smooth transitions is Count Downs.

Picture
These are what they sound like, when I count down time remaining at one event before we go to another. Something like "you've got ten minutes and then we're leaving" may not mean much to a child, but the way I do it is I count down the minutes. Even a child who doesn't know how long a minute is, but knows how to count (or even look at fingers and see them counting down) can figure out that as the numbers get lower, we're getting closer to leaving. Some kids may benefit from a more visual aid (a timer that you can watch the time tick away on, for instance), but this one works for us.

I used to do all fifteen minutes, plus a thirty second warning and then counted the last ten seconds. Now if I'm in a hurry I can do a mere five minutes, which I show on my hands (not even counting all the minutes - I'll generally give a 5 minute heads up, then 2, then 1, then thirty seconds and then ten seconds, which I also show on my hands). Just yesterday I guided a child who used to need fifteen minutes through a smooth transition where I only did the one minute, thirty second, and ten second cues. (It's so great to see how far we've come!)

Another parent had told me they'd tried transition time, but the child associated the warnings with anxiety. I had been concerned about that, too, so in an effort to make transition time not upsetting, when I first introduced it I tickled the child with the number of fingers that represented how many minutes we had left. It got to the point that when I started counting down the last ten seconds, he'd start giggling before I even touched him! Now he doesn't need the tickling, and when he wants to transition between activities, sometimes he'll simply ask me to count down the last ten seconds for him (as he giggles).

When to use transition time:
This really depends on the child. For me, I use transition time most often when a child is doing an activity they're really enjoying and is going to have to transition to something less enjoyable. For instance, when we're about to stop playing video games or leave the park. 

With one child who had anxiety particularly attached to people coming and going, I used it when I was about to leave and the parents were coming home. I also use it with children if we're suddenly changing up a routine, since that tends to be a pretty tricky situation to navigate. That way the child knows and gets reminders way ahead of time that instead of doing whatever we usually do, we're going to do something else and has time to adjust.

In essence, any transition between activities that might induce anxiety I use transition time with.

Support for transition time:

I like to check and confirm the tools I'm using to help kids on the spectrum with adults on the spectrum before I implement them. ANd when I asked autistic adults, they overwhelmingly told me that they thought transition time was a great idea that really would have helped them when they were growing up and I should keep doing it. Special needs teachers have also told me they support this, and it also turns out that, even though I'd already been doing this on my own, the psychologist for one of the children on the spectrum I care for has requested I do visual schedules, as well (not knowing I already was).

If that's not enough for you, there are also many, many studies supporting the effectiveness of tools to help autistic people with transitions. Here's an article which summarizes the findings of those studies that you can use on your own.


The tools for transitions I use are SO easy and so diminish anxiety (and therefore behavior) for the kids on the spectrum I use them with. I highly, highly recommend adopting transition time tools if you're not using them already.


-Creigh
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    About Creigh

    I'm a college student who grew up with my Autistic younger sister, Caley. I've got a bachelor's degree in Psychology and I'm currently studying for my Master's in Speech Language Pathology.

    Neither of those, however, have given me an understanding of autism. All of my understanding comes from learning from the many autistic people that I know. As a result, I have a very different outlook on autism than most, and a burning desire to tell the world what I've learned. This blog is one of the many areas in which I attempt to do that.


    *Note, none of these make me a professional, so advice I give is not professional advice.

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    Starting about in March 2014, all of these posts are originally published on Autism Spectrum Explained's Facebook page, and later reposted here for archiving purposes and easy access for ASE readers, including those who don't use Facebook. 

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