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Webchat on Promoting Language, Learning and Engagement in Toddlers and Preschoolers

December 1, 2011 3 comments

Thanks to all who joined us for today’s “Office Hour” webchat with our Chief Science Officer, clinical psychologist Geri Dawson, PhD. Here’s the full transcript.

Thursday December 1, 2011

12:30
Hello everyone. This is Dr. Geri Dawson. Thanks so much for joining me today. I am looking forward to reading your questions.
12:33
From Melanie
I am curious as to the research base on the consultative model and its impact in providing services with the very young child/toddlers with the diagnosis of ASD. Can this question be answered? Thanks
12:34
Hi, Melanie. Providing consultation to birth-to-three providers is a frequently used strategy for helping those providers learn to use ASD-specific intervention approaches. However, I am not aware of any empirical studies that compare a consultative model to direct intervention by specialists. The currently recommendation is for young children with ASD to receive direct one-on-one intervention with highly trained and well-supervised therapists for a significant part of their overall intervention program.
12:34
Comment From Julie

Hi Dr. Dawson. My son is 6 and he is echolalic and scripts a lot. any thoughts on how to best address both of these communication issues?

12:37
Hi Julie, Echolalia is a common way for kids with ASD to learn to speak. When your child echos back a word or phrase, treat it as a real communication regardless of whether it seems to make sense or not. Use part of the echoed speech but modify it to be more appropriate. For example, if he says, “You want cookie” when he wants something to eat, say “Cookie – you can say ‘I want cookie’ – and then give him what he wants. Continue to model appropriate speech incorporating parts of his echoed speech. The important thing is for him to feel successful in his attempts to communicate as this will keep his motivation high.
12:39
Comment From Troy S.

I do, but not sure how to ask it. It’s very general. We have a 2 yr old who hasn’t spoken a word. He was diagnosed at Kennedy Kreiger as being on the s[ectrum. And we are wondering if there are any realistic expectations of when we can expect him to speak his first words….?

12:41
Hi Troy, Many two year olds with autism have not yet developed speech. Is your child making any sounds at all? Vocalizing? If so, build on this sounds by imitating them, playing with sounds and songs, and always responding to his sounds as if they are meaningful communication, while modeling the correct word for hiim. Likely, he will start to use words eventually.
12:42
Comment From April Costello

@ Julie, there is a wonderful article which further reinforces Dr. Dawson’s recommendation. It is called Finding the Words, To Tell the “Whole” Story by Marge Blanc. It was a tremendous help to me in understanding my Son’s speech patters! :)

12:43
Hi April, There are many strategies that parents can use at home to promote language. You’ll want to use these throughout the day during your regular activities, such as mealtime, bathtime, at the park, and so on. Lynn Koegal has written a book called “Overcoming Autism” which describes many strategies that parents can use at home at promote speech. I think you will find that they are very helpful. Here is the link:
12:44
Comment From Shane Lynch

Based on Dawson and Osterling (1997) and the National Research Council (2001), family involvement has been cited as an element of best practice. However, unlike the other elements, family involvement is less quantifiable. Have you any thoughts on what “quantity” of involvement is related to improved outcomes? Thanks.

12:47
Hi Shane, Family involvement in early intervention is essential. Parents should be at the helm of any intervention program. Although it is difficult to “quantify” as you point out, the key points are that (1) parents should be involved in setting goals for their child that they find meaningful and important, (2) sensitivity to the individual family – their values, beliefs, culture, and so on is needed, (3) parents should be taught strategies for promoting skills at home using similar approaches that are being used at school and in therapy so that these skills can generalize to the larger community environment. The good news is that research is showing that parents can learn these strategies and are effective at using them to help their child.
12:49
Comment From Julie

Thanks. as far as scripting. He scripts a lot of TV/ movies and at inappropriate times, like during library time at school. Any ideas on how to manage it when it’s not approproate but also encourage him as he is learning new words through this avenue. many thanks!

12:52
Hi again Julie, The key thing here is to determine why and how he is using his echolalia. Does it signal that he is getting overwhelmed? Is he using it in a self-stimulatory fashion? Is he using it to communicate? Depending on the function, you will want to respond in different ways. For example, if he is using it in a self-stimulatory fashion in inappropriate places like library time, his teacher can teach him the idea of “quiet voice” – i.e. he should be reinforced for keeping quiet during the times when that is appropriate.
12:52
Comment From Matissa

Hi Dr. Dawson. I teach 2 & 3 year olds at a preschool and we have a few children within our program who are on the spectrum. What tips can you give us as we work with these children alongside neuro-typical children? Esp. as it pertains to class structure and discipline.

12:56
Hi Matissa, Children with autism tend to thrive in an environment that is structured, provides routine, and visual supports (such as pictures that explain the sequence of activities). The neurotypical children can be taught to help the children with autism by teaching the neurotypical children to approach and involve them in play. There are a number of well-established curricula and program features that have been used effectively for children with ASD. Here is a link that describes the features of a good preschool program:
12:56
Comment From Tami

Is sign language an appropriate tool? It seemed to help our neural typical child and I am wondering how commonly it is used with non-verbal children on the spectrum

12:59
Tami, I am not sure how old youg child is, but sign language can help a child with autism communicate. Sign language still can be challenging, however, because it involves complex motor movements and has its own syntax, and so on. So, often the signs used are simple ones. Spoken language, and perhaps other augmentative language devices, such as pictures, should always be used along with sign language.
1:02
Advance question From Breiana
My 2.5 year old son was diagnosed with autism 4 weeks ago. We were told to get him in ABA/VB. Is this the most effective method of ABA? What interventions do you recommend we do at home? We are also looking at preschools for when he turns 3. Do you typically recommend an inclusion preschool or an autism only preschool? Thanks
1:03
Applied behavior analysis (ABA) is a well-established effective intervention method for young children with autism. Within the broad category of ABA interventions, there are many different models, and Verbal Behavior (VB) is one of those approaches. There is no evidence that VB is more effective than other approaches that are based on ABA. The choice of classroom depends on many factors and the individual child. There is no one size fits all answer.Here is a good website that discusses how to evaluate a preschool program http://www.eric.ed.gov/PDFS/ED486480.pdf . Here are some features you should look for in a preschool program:
-The intervention program should be individualized to each child, taking into account each child’s unique characteristics, strengths, and challenges, and utilized well-validated intervention methods, such as ABA.
-The intervention program should be designed and overseen by a trained, professional, interdisciplinary team.
-A curriculum that focuses on the specific areas of challenges in ASD should be used.
-The program should provide for ongoing data collection on the progress the child is making in each skill area, with adjustments to the program made when progress is not evident.
-The child should be engaged in the intervention activities and receive at least 25 hours of structured intervention each week.
-Parents should be closely involved in the intervention, setting goals and priorities, and be taught how to implement the intervention strategies at home.
1:04
Hi Terry – A good article describing the important elements of an intervention program can be found at this link:
1:05
Comment From Tracy

Hello Dr. Dawson. Are there national standards in early interventions that you see most frequently used or cited?

1:06
Hi Tracy, Here is a document that describes national standards for early intervention:
1:07
National Autism Center. National Standards Project – Addressing the Need for Evidence-Based Practice Guidelines for Autism Spectrum Disorders, 2009.http://www.nationalautismcenter.org/pdf/NAC%20Standards%20Report.pdf
1:08
Comment From Guest

My daughter is struggling to learn how to handle and care for her 6yr old autistic child. We have been looking for resources but keep coming up empty. Any advise?

1:09
Hello Guest at 12:46, Please check out the Resource Guide From Autism Speaks’ Family Services:
1:09
Resources Guide from Family Services:
http://www.autismspeaks.org/family-services/resource-guide
1:10
Comment From Tami

My grandson is 6 and it seems as though his behavior changes weekly if not daily. When he does something wrong timeout did work, taking toys away did work, now it seems as though NOTHING works. Should an autistic child be punished? and if so what is the best form of punishment to use?

1:14
still typing …
1:14
Hi Tami, Children with autism often have behavioral challenges, such as tantrums and sometimes aggressive behavior. Often these behaviors are used to communicate a need or want. Given that children with autism have trouble with communicating with words, they use these behaviors instead. So, the first step is figuring out why the behavior is occuring and what your grandson is trying to communicate. Sometimes, the behavior occurs because the child is overwhelmed or frustrated. So reducing overwhelming situations and frustrations will help. But, ultimately, you will want to teach your grandson to communicate his needs in a more appropriate way. For example, if he tantrums when he wants something, you will want to make sure that you model for him how to ask for something appropriately (even if this is just helping shape his pointing toward an object) and then reinforcing that appropriate behavior by giving him what he is requesting. It is helpful to work with a trained professional who can help you use these strategies. I do not recommend punishment because these challenging behaviors are really the result of difficulties in communication.
1:15
Comment From Kristen

I wanted to add about Gabe that he has started to babble A LOT in the last month. He runs up to one of us and screetches AH or EE wanting us to mimic him. Can this lead to eventual speech? He is even making eye contact for periods of 3 to 5 seconds when we are doing this. Is there a way to mold this into more sounds. Right now he does not want to deviate from the 3 or 4 sounds he is comfortable with.

1:17
Hi Kristen, Wonderful!! It is such a good sign that Gabe is babbling a lot. Make sure to respond by imitating his babbling and, when appropriate, modeling a word that is simple and builds on the babbling sound. For example, “AH” can eventually become “BAH” and then “BALL”.
1:18
Comment From Bill

Dr Dawson, can you comment on how we could do a better job at individualizing the learning and communication for various ‘colors’ of the spectrum. many school districts, doctors and academics have a tendency to lump all of our kids into one ‘autism’ bucket (The DSM V may exacerbate this). How can WE better communicate these more individualized needs of the autistic children to the general population? What do you see us as the autism community need to do better?

1:20
Hi Bill,I couldn’t agree more. Kids with autism are each unique and each have their own ways of learning, strengths, and challenges. Although there are some general principles that are helpful for most kids, it is important to individualize each child’s program. Some children learn best through the visual modality and need lots of support to develop speech. Others are talking up a storm but are focusing on only one topic and need to learn how to engage in a conversation. A good educator or therapist should be identifying each child’s learning style and objectives and then developing an indivualized plan for that child.
1:22
Comment From Guest

Tami, sign language has been very helpful to my twin sons who are on the spectrum. It seems to have lead to words for one of my boys and it lessens frustration for the other.

1:22
Comment From Julie

We’re trying to integrate our son into the typical kindergarten classroom. Any advice to give on how to successful to this. His current classroom is 8 children all on the spectrum. The typical kindergarten classroom is 20 – 25 children. Thus far we’ve agreed to do it one subject at time, starting with library time, moving into music as these are the activities he enjoys the most.

1:24
Hi Julie, A good strategy is to familiarize your child with the teacher and classroom ahead of time, teaching him about the layout, routine, and so on. While he is in the classroom with other kids on the spectrum, identify the specific skills that he will need to be successful in the typical kindergarten classroom. Will he need to stand in a line, raise his hand, sit for long periods of time, and so on. Teach and practice those skills ahead of time and then help him generalize those skills to the typical classroom. In addition, start with short periods of time in the typical classroom during periods that are least challenging and then extend the amount of time he is there. Good luck!
1:26
Comment From Matissa

Will the transcript from this live chat be available for print after the chat is over? Would love to share this information and links with my fellow teachers.

1:26
Yes, we’ll be posting the transcript on our science blog. Here’s the linkhttp://blog.autismspeaks.org/category/science/
1:27
Comment From zenaida

My son is 6. I’m trying so hard to teach him to do the right thing. What he does is he takes his poop and puts it all over himself, the sink, door and towel. I don’t know how to stop this. I need help

1:29
Zenaida, I know this must be very challenging for you. I think it would be best if you could work with a behavior specialist who can help you get this behavior under control. Here is a link to resources in your area: If you can’t find someone, please contact us at Autism Response Team and we will help you sort this out. Here is the link:
1:31
Comment From Tiffany

My non-verbal 4 year-old has just been diagnosed on the spectrum and has been in early intervention programs and speech therapy since she was 2. It seems like she has been on the verge of of communicating vrbally for the last year, she says words here and there, just not consistently. We have been advised to get her in an ABA program, but our insurance won’t cover it. What other resources do you suggest to get our little girl consistently communicating?

1:33
Hi Tiffany, Your local school is obligated to provide preschool programming for your child, so be sure to take advantage of that. You can also use strategies at home. Lynn Koegal’s book “Overcoming Autism” describes many strategies for promoting speech and language that parents can use at home. The fact that your daughter is saying words here and there is a very positive sign. Be sure to imitate those words and reinforce them by responding to them.
1:35
Dear everyone, I am sorry that the hour is over and went so quickly. I wish I had more time to respond to each one of your questions. Please visit Autism Speaks’ website, especially the Family Services section, to find many resources and tool kits for families. I will be holding another chat in the future so I hope we will have a chance to communicate again. Best wishes, Dr. Dawson
1:36
Transcript coming on our science blog:http://blog.autismspeaks.org/category/science/

A Weatherstone Grad Reflects on Entering Autism Research

November 29, 2011 5 comments

Posted by Dennis Weatherstone Pre-Doctoral Fellow Elaine Hsiao

 

Nearly seven years ago, I made the all-important decision to pursue a future in scientific research. I was inspired by the ability of research to humble far-fetched ideas into reality, and I wanted to help uncover knowledge that would serve as an indispensable foundation for the advancement of medicine, technology and industry. Importantly, I saw an opportunity to evoke change in a way that improves lives.

As I enter my fifth year of studying the molecular underpinnings of autism, it is precisely these real-life applications of scientific research that continue to motivate me. I am grateful for the support of Autism Speaks and its numerous donors, in defending the realization that only by pushing the frontiers of science will solutions to today’s most pressing problems be found.

As an Autism Speaks Weatherstone fellow, I have been studying maternal infection as a primary environmental risk factor for autism, under the guidance of neurobiologist Paul Patterson, PhD, at the California Institute of Technology. Using animal models, we are uncovering the biological pathways that implicate infection in the development of core behavioral symptoms of autism as well as associated alterations in brain development. We are further exploring means for effective prevention and treatment, with aims to translate our findings to the identification of potential biomarkers and targets for effective therapies.

Support from the Weatherstone fellowship has also allowed us to explore the potential connections between gastrointestinal (GI) complications, immune dysregulation and behavioral symptoms in animal models for autism. We are very excited that this is now part of a larger collaborative research effort supported by Autism Speaks, with the aim of better understanding gastrointestinal GI and immune dysfunction in certain subsets of persons affected by autism.

In addition to providing financial support for my studies, the Weatherstone fellowship has given me unique opportunities to interact with leading scientists in autism research. I am truly inspired by the breadth and depth of research being conducted by my Weatherstone colleagues and by scientists worldwide. Exchanging ideas with scientists from other laboratories and disciplines greatly informs my own work.

Finally, I am deeply grateful to Autism Speaks and the Weatherstone fellowship for providing unique forums for scientists to interact with individuals and families directly affected by autism. Being able to convey the promises, obstacles and advances of autism research to the community is not only rewarding, but also very constructive. Likewise, my time with these individuals and families—time spent learning about their experiences and needs—drives my desire to conduct autism research that is innovative and informative.

With the valuable training I have received through doctoral research combined with the unique experiences I have gained as a Weatherstone fellow, I feel prepared to pursue a productive career in scientific research, with aims to uncover knowledge that will better our understanding of autism’s causes and lead to the development of more effective tools for its diagnosis and treatment. 

[Editor’s note: Administered by Autism Speaks and funded by the Stavros Niarchos Foundation, the Dennis Weatherstone Predoctoral Fellowship Program encourages the most promising young scientists to choose autism research as their career through funding and direct mentoring by the field’s leading investigators.)

Read more news and perspective on the Autism Speaks science page.

My child is sometimes aggressive – what can help?

October 7, 2011 44 comments

This week’s “Got Questions?” response comes from Simon Wallace, PhD, Autism Speaks director of scientific development for Europe.

A few months ago, I was visiting an autism clinic in Albania, one of the underserved countries where Autism Speaks is making a difference through our Global Autism Public Health Initiative. There I met a three-year-old girl receiving a diagnostic assessment for autism. Clearly, she wanted her parents to stop talking to us and take her outside. She kicked her father and bit his hand and then began slapping her own head. This young girl was trying to make her preferences known but lacked speech. Aggression was her way of communicating her needs.

Whatever their age, some individuals on the autism spectrum act out aggressively, and clearly, this can be distressing for everyone involved. In fact, aggression is among the most common challenges reported by parents of children and adolescents with autism.

What can help? I suggest working with your child’s physician and therapists on a four-stage approach to tackling this and other problem behaviors. The four steps are identification, understanding, management, and prevention.

By identification, we mean characterizing the problem behavior. As parents, you can write down the type of aggression your child demonstrates along with the time and setting of when the behavior occurs.

Next comes understanding. Specialists often use tools such as the Functional Behavioral Assessment decipher why a person with autism is behaving a certain way. In other words, what is the function of a given behavior for the person with autism? Is she telling you she doesn’t like what you’re doing?  Is he telling his teacher that the school work is too complex? Does she want something she cannot have? Identifying the “communication” behind the behavior is the first step to teaching appropriate behaviors that can convey the person’s needs and desires.

In addition, underlying problems can trigger aggression. Among those with autism, common triggers include disturbing breaks in routine, lack of sleep, jarring “sensory stimuli” (noises, lights, or smells) or even undiagnosed mental health problems. Clearly, it’s important to look beyond the behavior itself to identify the underlying cause.

When it comes to managing aggression, there are many options. The information you gathered in identifying and understanding your child’s behavior may guide you and your child’s healthcare providers in developing a plan.

An abundance of research supports the effectiveness of Applied Behavior Analysis (ABA) in helping children with autism learn new and effective behaviors—so that aggression is no longer needed to communicate wants and needs. Research as shown that, in many cases, ABA alone is effective in reducing aggressive behaviors.

When ABA is not effective, it is important to consider the possibility of an underlying medical condition. For example, we know that autism is frequently associated with sleep disturbances and gastrointestinal distress. Disrupted sleep is likewise associated with uncontrolled seizures. Addressing these medical conditions can make a difference in reducing aggressive outbursts. Also remember that the sudden onset of aggression may signal that your child is in pain, ill, or simply exhausted.

Medication has been used successfully to reduce aggression and self-injury in both children and adults with autism. Risperidone, in particular, has gone through extensive testing in this regard.  Both risperidone (Risperdal) and aripiprazole (Abilify) are approved by the U.S. Food and Drug Administration (FDA) for treating autism-related irritability, which includes aggression, tantrums, and self-injury. A recent study demonstrated that a combination of parent training (in behavior intervention) and risperidone reduced tantrums and other problematic behaviors in children with autism to a greater degree than did medication alone.

However, the decision whether or not to use behavior modifying medication is can be difficult. Autism Speaks has developed a medication decision aid to help you work with your child’s physician to determine whether this option fits your family’s goals and values. (Available for free download on our Tools You can Use Page.)

Finally we have prevention. Strategies to prevent aggression include working with your child’s therapists and teachers to create calming, predictable, and rewarding environments. Other helpful approaches include visual timetables and structured schedules—both of which can help smooth transitions between activities. Rewarding positive behavior and providing communication tools are additional strategies that many families find helpful.

I hope some of these suggestions help your child and family. And readers, I’d love you to use the comment section to share resources and ideas you’ve found useful.

In Their Own Words – Mean People

September 2, 2010 304 comments

This “In Their Own Words” is by Jennifer C., whose three-year-old daughter, Sierra, was diagnosed with autism at 20 months. You can read more of her writing at http://fingerprintsofautism.blogspot.com/.

My family went out to eat last night at a restaurant here in town. We usually go to kid-friendly ones that are pretty noisy already. If any of you have an autistic child you know how they cannot control their volume very well. Sierra is very loud and she doesn’t speak that well yet either, but she talks all the time and she squeals a lot when she is having fun. She was happy and being silly, a far cry from a year ago when she didn’t talk and just cried and yelled when we took her out. We try to teach her how to use an inside voice when we are out, but she does it for a minute and goes right back to being loud.

There were two elderly women sitting across the aisle from us who were just horrified by Sierra; they held their ears and shot glances at us, like my child was throwing knives at them. I do usually apologize for her being loud and I did to the other tables closer to us, but they were being nice about it. It wasn’t a constant loudness; she was being very good – eating her food and just being silly because other people were playing with her and her baby sister. When we were done, my husband got up to pay the bill and that’s when one of the elderly women said to me, “Can you keep your kid quiet or does she have to screech like that?”

I almost choked on my french fry. I have never had someone be so mean about it. If she had actually took a minute to look at Sierra, she would have noticed that she doesn’t talk clearly in any way and that she uses sign language while she is “screeching,” as she put it. That might have been a clue that maybe my child makes noise like that because she does not know how to communicate properly yet! I just said in a very loud and mad tone, “She is autistic and she does not understand how to be quiet!” Then she just gave me a blank look and said, “Okay”.  I know she was a coward because she waited until my husband left the table to say it. I hope she was embarrassed. There was so much more I wanted to say but I just couldn’t get it out. I get so upset, then I start to cry and I didn’t want them to see me cry.

I think people are very judgmental about autistic children. They don’t look close enough to see that there might be something wrong with the child; all they see is an unruly child. If they walked in our shoes for one day, they would never be judgmental about another child and their family again. The next time you see a child crying by the gumball machines, it might not be that she is having a temper tantrum for candy; it could be my daughter crying because they changed what is in the machines. At the restaurant, she is crying because the chicken is stringy and she can’t eat stuff with strings hanging off. At the park, it’s because the other kids scare her. At the grocery store, it’s because we walked a different way through the store. Sierra very rarely cries because she can’t have a toy; she cries when her routine changes or when she has trouble communicating her needs, and she gets unruly when she is scared and or on uncommon ground. Imagine having to live life like that and you will think twice about being judgmental.

I love my daughter so much and I wish other people could see her through my eyes, how wonderful, loving, and smart she is, and how frustrated she gets trying to adapt in this world. It breaks my heart every day knowing that she will have to put up with mean people who don’t understand her and what autism is.

“In Their Own Words” is a series within the Autism Speaks blog which shares the voices of people who have autism, as well as their loved ones. If you have a story you wish to share about your personal experience with autism, please send it to editors@autismspeaks.org. Autism Speaks reserves the right to edit contributions for space, style and content. Because of the volume of submissions, not all can be published on the site.

How Becoming a Therapist Changed My Life

July 1, 2010 6 comments

This is a guest post by Emily Mandel. Emily is a student at Brandeis University who is training in ABA therapy.

This summer I am interning at a center called Greenwich Education and Prep in Cos Cob, Connecticut, learning to be a therapist for children with autism using Applied Behavior Analysis (ABA) under the supervision of Dr. Mindy Rothstein and her colleagues. Initially, ABA was what I expected it to be: a therapy involving reinforcement of positive solicited behaviors. “Alex, look at me… Alex… Alex, what do you have to say? Say it to my face. Very good! You earn a point toward winning your candy.” However, until I began this training, I had not realized how multi-faceted and complicated ABA is. I had assumed it was the same method of therapy for every child, and that if it did not work it was not the right therapy for the child. What I’ve been observing, however, is quite contrary to my expectations.

Each child has a unique program designed to address the specific preferences, strengths, and areas of challenge. For example, if a child has trouble with eye contact and following directions, the instructor will reinforce eye contact and direction-following with prizes the student can earn after obtaining a certain number of “points.” In addition, the instructor prepares various activities to address each of the areas of difficulty, and monitors the progress made in each activity. For example, that same child with difficulty making eye contact and following directions is given a task like a puzzle and prompted to make eye contact each time a direction is given regarding the puzzle.
Over my summer so far, I’ve seen such changes in the children. I am pleased to see how far each child has progressed using ABA intervention techniques.. Most times forms of therapy– including ABA –benefit from the accompaniment of other forms of therapy. However, I’ve come to believe that ABA is fundamental; the ABA program targets each specific area of challenge for the child. I cannot wait to see how the children I am working with progress over the course of the rest of the summer, and how they will continue to progress throughout their lives.

I’ve made the decision to go through the certification process for Applied Behavior Analysis after I earn my Bachelor’s Degree in Psychology from Brandeis University. Greenwich Education and Prep has truly shown me the cognitive leaps and bounds children with autism can make.  I hope to one day be able to change the lives of these children and their families through this fundamental method of therapy. I’ve seen what ABA can achieve, and I know that this is what I want to do with my life.

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