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The "Stepwise Integration" Method for Fine Motor Skills Deficits

“I need some advice on how to help my daughter with high functioning autism to dress herself. She is 6-years-old, and I still have to help her with the buttons on her sweater, tying shoes, etc. I would have thought she could be doing this on her own by now. Does anyone else have this problem?”

Stepwise integration is a good strategy to use in these circumstances. Kids with Asperger’s (AS) and High-Functioning Autism (HFA) often have difficulty with fine motor skills, which involve strength, fine motor control, and dexterity (e.g., the small muscles of the body that enable such functions as grasping small objects, writing, tying shoe laces, fastening clothing, etc.).

These skills are important in most school activities as well as in life in general. Deficits in fine motor skills can affect a youngster's ability to eat, write legibly, use a computer, turn pages in a book, and perform personal care tasks (e.g., dressing and grooming).



Dressing is a simple task for most kids, and most moms and dads expect their kids to be able to correctly dress themselves after a certain age. But for young people with AS and HFA, even the simple act of dressing is not stress-free. To help your daughter with a simple task like dressing, employ a stepwise integration method by breaking the task down while you do it for her. Then, gradually have her perform the steps by herself, giving her an extra step each time.

For instance, the first part of stepwise integration of dressing is helping your daughter get dressed while you explain every action (e.g., choose the sweater, lay it on the bed, put one arm through the hole, put the other arm through the hole, and button the sweater).

The next step (performed the next morning) is to have her choose the sweater, with you completing the remaining actions.

The following day, have her choose the sweater and lay it on the bed. Continue giving your daughter more actions until she is doing the entire process on her own.





 

COMMENTS:

•    Anonymous said... Break down the steps of doing buttons. You do the first couple of steps and get her to do the last step. Eg. You hold the button, you take hold of button hole, you push button half way through button hole then get your daughter to pull the button through. As her skills get better, get her to do the 2 last steps and so on and so forth until she is doing it by herself. It may take time but it will happen. Do the same for shoe laces. Get her to do the first step of crossing the laces over and pulling down, then you do the other steps and as her skills get better she can tackle the other steps. Forget about her age, it should be about showing her in steps so she can gain the skills to be independent. There are many children and adults that are still learning those skills. Believe in your daughter because she believes in you.
•    Anonymous said... I was still helping my daughter with buttons, laces etc when she was 12. She's 15 now and apart from the odd teeth brushing prompt she's fine. These things take time but your daughter will get there. Have patience and don't make a big deal out of it.
•    Anonymous said... My sons 8 and just this year starred doing buttons on his shirts but not pants. We only buy him pull on pants. Thank goodness for Velcro shoes and squiggly laces. Might as well compromise now to save yourself the stress. They will be doing buttons and laces one day.
•    Anonymous said... Same problem with my 8 year old boy.
•    Anonymous said... took a very long time for my guy to master laces, maybe age 9, and that was a skill taught in OT.
*   I have same issues with my 7 year old son. He is HFA and Aspergers. I am going to try the Step Wise Intergration method and see where I get with my little man.

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Medication for Treating Aggression in Asperger's Children

“Are there any medications that can be used to treat aggression in a child with Asperger syndrome? Is it ever advisable to use medication for this purpose?”

Aggression is seldom an isolated problem and is particularly complex in kids with Asperger’s (AS) and High-Functioning Autism (HFA). Aggressive behavior is not always associated with just one condition and can have highly varied sources.

Many studies have been proposed to understand aggressive behavior in young people with AS and HFA. There are promising biologic models that suggest the behavior arises from alterations in dopaminergic reward mechanisms, and cognitive models suggesting that such acts are an outcome of conditioned learning.



Tantrums and aggression are often responses to an array of circumstances and occur in the context of varied emotions. Circumstances preceding and following aggressive outbursts should be observed and documented before selecting a particular medication (e.g., when aggression is a response to anxiety or frustration, the most helpful interventions target those symptoms and the circumstances that produce them, rather than exclusively focusing on the aggressive behavior itself).

Unfortunately, the request for medication typically follows a crisis. The press for a rapid, effective end to the unwanted behaviors may not permit the gathering of much needed data or discussion. Nonetheless, it is not appropriate to “always” begin with one medication or another. Moving to a more “surefire” medication too quickly may mean that the AS or HFA child takes on cardiovascular, endocrinologic, and cognitive risks that may be otherwise avoided.

There are studies in support of using serotonin reuptake inhibitors, alpha-adrenergic agonists, beta-blocking agents, mood stabilizers, and neuroleptics for aggressive behavior. When the doctor has the (a) luxury of time, (b) support of the child’s parents, and (c) collaboration with school staff where the child is attending school, then a medication that is safer, but perhaps takes a longer time to work (or is a little less likely to help) can be tried.

As a side note, it does appear that medications with a greater likelihood of success pose greater risks (e.g., evidence supports use of dopamine blocking agents for aggressive behavior; however, the side effects and long-term risks from these medications are greater than others listed earlier).

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Behavioral and Cognitive Rigidity in Children with Asperger’s

Behavioral rigidity refers to a child’s difficulty maintaining appropriate behavior in new and unfamiliar situations. The opposite of rigidity would be flexibility, which enables children to shift effortlessly from task to task in the classroom, from topic to topic in conversation, from one role to another in games, etc.

Rigidity can also affect thinking. Cognitive rigidity occurs when the child is unable to consider alternatives to the current situation, alternative viewpoints, or innovative solutions to a problem. The child with rigid thinking tends to view things in “either-or” terms (e.g., things are either right or wrong, good or bad). He or she wants concrete, black and white answers. The “gray areas” of life are very uncomfortable (e.g., often has an exact way of doing things with no variations).

Children with Asperger’s (AS) and High-Functioning Autism (HFA) often demonstrate extreme forms of rigidity or inflexibility. This may manifest itself as (a) difficulty ending an intense emotional feeling, (b) making transitions during the school day (e.g., from lunch back to the classroom), and (c) tolerating changes in schedules or everyday routines. 

==> Here is a 3-step process for helping your AS or HFA child with his/her rigidity issues...




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Your Rights as a Parent of a “Special Needs” Child

Most kids with Asperger’s and High Functioning Autism experience problems in school, ranging from difficulties with concentration, learning, language, sensory sensitivities, and making/keeping friends. Young people with such “special needs” are usually entitled to receive additional services or accommodations through the public schools.

Federal law mandates that every youngster receive a free and appropriate education in the least restrictive environment possible. To support their ability to learn in school, three Federal laws apply specifically to special needs students:
  1. Section 504 of the Rehabilitation Act of 1973
  2. The Americans with Disabilities Act (ADA) (1990)
  3. The Individuals with Disabilities Education Act (IDEA) (1975)

Different states have different criteria for eligibility, services available, and procedures for implementing these laws. It is important for moms and dads to be aware of these laws and related regulations in their particular area.

1. Section 504 is a civil rights statute that requires that schools not discriminate against kids with special needs and provide them with reasonable accommodations. It covers all programs or activities – whether public or private – that receive any federal financial assistance. Reasonable accommodations include modified homework, provision of necessary services, sitting in front of the class, and untimed tests. Typically, kids covered under Section 504 either have less severe deficits than those covered under IDEA, or have deficits that do not fit within the eligibility categories of IDEA. Under Section 504, any child who has an impairment that substantially limits a major life activity is considered disabled (learning and social development are included under the list of major life activities).

2. The ADA requires all educational institutions (other than those operated by religious organizations) to meet the needs of kids with psychiatric disorders. The ADA prohibits the denial of educational services, programs or activities to children with disabilities and prohibits discrimination against all such young people.

3. IDEA is a federal law that governs all special education services for kids in the U.S. Under IDEA, in order for a youngster to be eligible for special education, he or she must be in one of the following categories:
  • autism
  • learning disabilities
  • mental retardation
  • physical disabilities
  • serious emotional disturbance 
  • traumatic brain injury
  • vision and hearing impairments
  • other health impairments

As a mother or father, you may request an evaluation of your youngster to determine his/her needs for special education and/or related services. The evaluation may include a behavioral analysis, educational testing, an occupational therapy assessment, psychological testing, and/or a speech and language evaluation. These are the steps that parents of special needs children need to take:
  • Keep careful records, including observations reported by your youngster's educators and any communications (e.g., notes, reports, letters, etc.) between home and school.
  • Meet with your youngster's educator to share your concerns and request an evaluation by the school's study team. Moms and dads can also request independent professional evaluations. 
  • Submit your requests in writing for evaluations and services.
  • Also, always date your requests and keep a copy for your records.

The results of the evaluation determine your youngster's eligibility to receive a range of services under the applicable law. Following the evaluation, an Individualized Education Program (IEP) is developed. Examples of categories of services in IEPs include speech and language therapy, physical therapy, occupational therapy, and/or the provision of a classroom aide. The parent does not determine whether the youngster is eligible under the law; however, the parent is entitled to participate in the development of the IEP. Additionally, the findings of the school's evaluation team are not final. Parents have the right to appeal their conclusions and determination. The school is required to provide parents with information about how to make an appeal.

Moms and dads of a special needs child should always advocate for their youngster, be proactive, and take necessary steps to make sure their youngster receives appropriate services. The process can be confusing and intimidating. Here are a few important points to consider:
  • If the school district does not respond to the parents’ request, parents can contact a U.S. Department of Education Office of Civil Rights Regional Office for assistance.
  • If the school district refuses services under the IDEA or Section 504 or both, parents can choose to challenge this decision through a due process hearing (i.e., a legal hearing in which parents and the youngster have an advocate who can help express the parents’ views and concerns). 
  • It may be necessary to retain your own attorney if you decide to appeal a school's decision. This attorney can take the school to court, but most schools that get contacted by an attorney will begin to cooperate with you. They would rather pay for your child's equipment than the cost of an attorney and a court case. 
  • Moms and dads should request copies of their school district's Section 504 plan. This is especially important when a school district refuses services.

Here is a summary of your rights as a parent of a special needs child. You have the right to:
  • ask for an independent educational evaluation at public expense when you disagree with the school district’s assessments
  • bring any person to an IEP meeting with knowledge of the child or the child’s disability, including advocates and attorneys
  • consent, refuse to consent, or revoke consent for special education for your child
  • file complaints, including state complaints, due process complaints, and disagree with parts or all of the IEP
  • list all of your concerns in the IEP
  • participate in the IEP meeting and have your opinions heard and noted
  • receive prior written notice when the school district proposes a change in your child’s placement or refuses your request
  • request a new IEP meeting be held within 30 days of a written request when an IEP is already in place
  • request that your child be assessed for Special Education without delay
  • review and receive copies of your child’s educational records

Kids on the autism spectrum who have “special needs” can't take care of themselves. They rely on their moms and dads to make sure they are protected. It can be stressful and difficult for parents if they don't know what their child’s rights are – let alone how to protect him or her. Parents can follow the steps listed above to protect the rights of their youngster.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

 ==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

 ==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

 ==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

 ==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book
==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism


COMMENTS:

•    Anonymous said... My son needed big help with social issues at school, I ended up writing to the Minister of Education, Hon Anne Tolley at the time, only after her and Chester Burrows getting on board did I get help by our GSE. Then the following term the RBLT removed him from her books saying he was fine. Changed schools and the next school was brilliant.
•    Anonymous said... This is a very good article. Pay close attention to the keeping records part. You will have to fight for it. The school will want to collect "data"...so keep records of everything. If your school has an online program so you can look at your kids assignments and grades, print out the assignments and grades after every semester/quarter. Having that in my hand and pointing out that my child made all "A"s" when she did the work, and "F's" only when she didn't do the work (which was often.... any time she thought it was a stupid assignment, involved a lot of writing or she thought she couldn't do it perfectly) helped me finally get the 504 and some very needed accommodations. Be persistent, be a bitch if you have too, but stay on them. They have to respond to your requests in specific number of days, but often won't. Stay focused and know the prize will make a difference for your child!!
•    Anonymous said... We have a 504 for my daughter! Soooo helpful.

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How Important is a Diagnosis?

If you suspect that your child has ASD level 1 (Asperger's), even if he or she is an adult, should they seek a formal diagnosis?

Answer: It depends!



==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance
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