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Making Sense of the DSM-5: "Severity Levels" of Autism

“My granddaughter (7yrs old) was just diagnosed with autism and level 1.5. What does that mean and what's the differences between that and aspergers?”

To answer this question, let’s first look at the new criteria for Autism as described in the DSM 5:

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history):
  1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
  2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
  3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history:
  1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
  2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
  3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
  4. Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).



C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and Autism spectrum disorder frequently co-occur; to make comorbid diagnoses of Autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

The DSM 5 specifies the severity levels of Autism as follows:

Level 1: Requiring Support—
  • Social Communication: With supports in place, deficits in social communication cause noticeable impairments. Has difficulties initiating social interactions, and demonstrates clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions.
  • Restricted Interests and Repetitive Behaviors: Rituals and repetitive behaviors (RRB’s) cause significant interference with functioning in one or more contexts. Resists attempts by others to interrupt RRB’s or to be redirected from fixated interest.

Level 2: Requiring Substantial Support—
  • Social Communication: Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with social supports in place; limited initiation of social interactions and reduced or abnormal response to social overtures from others.
  • Restricted Interests and Repetitive Behaviors: RRB’s and/or preoccupations or fixated interests appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress or frustration is apparent when RRB’s are interrupted; difficult to redirect from fixated interest.

Level 3: Requiring Very Substantial Support—
  • Social Communication: Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning; very limited initiation of social interactions and minimal response to social overtures from others.
  • Restricted Interests and Repetitive Behaviors: Preoccupations, fixated rituals and/or repetitive behaviors markedly interfere with functioning in all spheres. Marked distress when rituals or routines are interrupted; very difficult to redirect from fixated interest or returns to it quickly.

So as you can see, Level 1 would be considered high-functioning Autism. Disability will be common among children with Level 3 Autism and non-existent in Level 1 (where children currently diagnosed with Aspergers will be reclassified).




The new method for diagnosing Autism replaces the five prior diagnoses: Asperger Syndrome, Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), Childhood Disintegrative Disorder, and Autistic Disorder. If a child has a pre-existing diagnosis of any of these disorders, he or she is automatically considered to have an Autism diagnosis.

Children who are being newly diagnosed (or re-evaluated) and do not fit into the new criteria for Autism may receive a new diagnosis called Social Communication Disorder. This appears to be an extremely mild version of Autism (the child does not have sensory issues or repetitive behaviors) and is similar in many ways to the old PDD-NOS.

The DSM-5 defines Autism as a single “spectrum disorder,” with a set of criteria describing symptoms in the areas of social communication, behavior, flexibility, and sensory sensitivity. If a child has symptoms in these areas, he or she will probably be diagnosed as “on the spectrum.” When a physician diagnoses a youngster with Autism, it's important to know the severity of the disorder. If the physician does give his/her opinion on the severity, it’s with the disclaimer that it’s only an opinion, not a medical diagnosis. Whether the opinion is that it's severe, or that it's mild, it has no bearing on the actual diagnosis. A youngster with Autism deemed as mild is just as autistic as one believed to be severe. The medical diagnosis for both is exactly the same.

Autistic kids have issues with social interactions, behavioral issues, restricted interests, self-stimulatory activities and sensory issues. So severity in each of these categories needs to be determined to assess severity as a whole. While the severity of Autism is not a diagnosis, physicians who specialize in Autism can tell where a youngster is in relation to the other kids they have treated. The same youngster will get different opinions of severity from different people. Since determining a “Level” is subjective and not a technical diagnosis, there is no right or wrong answer.

The three Autism “levels” raise many questions, for example:
  • Depression and anxiety are very common traits among children on the Autism Spectrum, and this can cause major challenges in typical settings. If a child is bright, verbal and academically capable – but moody and anxious, and therefore in need of significant support in order to function at school – where does he or she fit in?
  • Some children on the Autism Spectrum do fine at home, but need help in the classroom. Others do well in the classroom, but not at home (where there’s less structure). So, in which social settings do children at various levels require “support?”
  • Some autistic children have received adequate therapy to appear “close to normal” when interacting with adults – but have significant problems when playing/interacting with their friends. Others get along well with peers, but not adults (especially authority figures). What type of support do they need?

The severity of Autism changes not only day to day, but also situation to situation. For example, autistic kids may exhibit significant social deficits when trying to play with their peers on the playground -- but in the classroom, they may blend in perfectly with their peers. Autism severity is simply a place to start. It’s something to use to help the youngster make progress by getting more services and to help describe the youngster to therapists, teachers, etc. It’s just a snapshot, not something that reflects the future or the youngster in all situations.

Resources for parents of children and teens on the autism spectrum:
 
 

Sources:
  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC.
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.
 
 
Best comment: Thank you for the great explanations to the new DSM-5. I shared this on my FB page -- your blogs (and your book) are so helpful to me as the mom of a 15-year old Aspie. After reading this, I actually kind of like the new classification. My son wasn't "officially" diagnosed with high-functioning autism until he was 14, because prior to that he had been just diagnosed as ADD, bipolar, and OCD, although they did diagnose correctly the sensory processing disorder when he was 7 (with "borderline Aspergers" at that time as well). He began ABA therapy for the first time just 8 months ago, and started at a non-public school (specifically for kids with autism) five months ago. Between those two major changes in his life, we have seen remarkable improvements in his daily functioning. So it seems to me that it is possible to transition from one level to another due to outside influences, don't you think? Thank you again for such a great post!
By

Seeking a Diagnosis for Asperger's & High-Functioning Autism

This video answers the questions: If I think my child has Asperger's, should I have him diagnosed? If so, when? And how do you get a diagnosis?





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Best Parenting Practices for Raising "Newly Diagnosed" Kids on the Autism Spectrum

"We recently learned that our son has High-Functioning Autism and are concerned about how to approach this new challenge.... his triggers, learning problems, treatments, added stress to our family, how to explain autism to him... etc."

Moms and dads can do a lot to help their kids with High-Functioning Autism and Asperger’s Syndrome. But, it's important to make sure you get the support you need. When you're raising a youngster on the autism spectrum, taking care of yourself is not an act of selfishness—it's a necessity! Being emotionally strong allows you to be the best mother or father you can be to your “special needs” son or daughter.

If you've recently learned that your youngster has High-Functioning Autism (HFA) or Asperger’s (AS), you're probably wondering and worrying about what comes next. No parent is ever prepared to hear that a youngster is anything other than happy and healthy, and a formal diagnosis can be particularly scary. You may be unsure about how to best help your youngster. You might be confused by conflicting treatment advice. You may have been told that High-Functioning Autism is an incurable, lifelong condition, leaving you concerned that nothing you do will make a difference. These are all common responses.



While it is true that High-Functioning Autism is not something a child simply "out-grows," there are many treatments that can help these kids learn new skills and overcome a wide variety of developmental challenges. Assistance is available to meet your youngster's special needs. With the right treatment plan and a lot of love and support, your youngster will learn, grow and thrive.

Best tips for parents with newly diagnosed children on the autism spectrum:

1. Rather than focusing on how your HFA or AS youngster is different from other kids and what he is “missing,” practice acceptance. Enjoy your kid’s special quirks, celebrate small successes, and stop comparing him to others. Feeling unconditionally loved and accepted will help your youngster more than anything else.

2. Kids with High-Functioning Autism have a hard time adapting what they’ve learned in one setting (e.g., the therapist’s office or school) to others, including the home. Creating consistency in your youngster’s environment is the best way to reinforce learning. Find out what your youngster’s therapists are doing and continue their strategies at home. Explore the possibility of having therapy take place in more than one place in order to encourage your youngster to transfer what she has learned from one environment to another. Also, be consistent in the way you interact with your youngster and deal with challenging behaviors.


3. Become an expert on your youngster. Figure out what triggers his disruptive behaviors and what elicits a positive response. What does your HFA youngster find stressful? Calming? Uncomfortable? Enjoyable? If you understand what affects him, you’ll be better at troubleshooting problems and preventing situations that cause problems.

4. When it comes to treatment for High-Functioning Autism, there are a variety of therapies. Some focus on reducing problematic behaviors and building communication and social skills, while others deal with sensory integration problems, motor skills, emotional issues, and food sensitivities. With so many choices, it is extremely important to do your research, talk to treatment experts, and ask questions. But keep in mind that you don't have to choose just one type of therapy.

The goal of treatment should be to treat all of your youngster's symptoms and needs. This often requires a combined treatment approach that takes advantage of many different types of therapy. Common HFA treatments include speech-language therapy, play-based therapy, physical therapy, occupational therapy, nutritional therapy, and behavior therapy.

5. Secure a private spot in your home where your youngster can relax, feel secure, and be safe. This will involve organizing and setting boundaries in ways your youngster can understand. Visual cues can be helpful (e.g., colored tape marking areas that are off limits, labeling items in the house with pictures). You may also need to safety-proof the house, particularly if your youngster is prone to wild tantrums or other self-injurious behaviors.

6. Create a personalized treatment plan. And keep in mind that no matter what treatment plan is chosen, your involvement is vital to its success. You can help your youngster get the most out of treatment by working hand-in-hand with the treatment team and following through with the therapy at home. When putting together a treatment plan for your youngster, remember that there is no single treatment that will work for every child. Each boy or girl with High-Functioning Autism is unique, with different strengths and weaknesses.

Good questions to get answers to include: How does your youngster learn best (e.g., through seeing, listening, or doing)? What are your youngster’s strengths? What are your youngster’s weaknesses? What behaviors are causing the most problems? What does your youngster enjoy and how can those activities be used in treatment? And, what important skills is your youngster lacking? A good treatment plan will: (a) teach tasks as a series of simple steps; (b) provide regular reinforcement of behavior; (c) offer a predictable schedule; (d) involve the mother and father; (e) build on the youngster's interests; and (f) actively engage the youngster's attention in highly structured activities.

7. Think positive. It’s impossible to predict the course of High-Functioning Autism. Don’t jump to conclusions about what life is going to be like for your youngster. Like everyone else, children on the spectrum have an entire lifetime to grow and develop their abilities.


8. As the parent of a youngster with High-Functioning Autism, the best thing you can do is to start treatment right away. Seek help as soon as you suspect something’s wrong. Don't wait to see if your youngster will catch up later or outgrow the problem. Don't even wait for an official diagnosis. The earlier kids with on the autism spectrum get help, the greater their chance of treatment success. Early intervention is the most effective way to speed up your youngster's development and reduce related symptoms.





9. Every mother or father needs a break now and again. And for a parent coping with the added stress of High-Functioning Autism, this is especially true. In respite care, another caregiver takes over temporarily, giving you a break for a few hours, days, or even weeks. Look for respite care options in your area.

10. Figure out the need behind the tantrum. It’s only natural to feel upset when you are misunderstood or ignored, and it’s no different for kids with High-Functioning Autism. When an HFA boy or girl acts-out, it’s often because the parent is not picking up on the child’s nonverbal cues. Throwing a tantrum is his or her way of communicating frustration and getting the parent’s attention.

11. If stress, anxiety, or depression is getting to you, see a therapist of your own. Therapy is a safe place where you can talk honestly about everything you’re feeling. Marriage or family therapy can also help you work out problems that the challenges of life with an HFA youngster are causing in your marriage or with other family members.


12. Joining a support group is a great way to meet other parents dealing with the same challenges. Moms and dads can share information, get advice, and lean on each other for emotional support. Just being around others in the same boat and sharing their experience can go a long way toward reducing the isolation you may feel after receiving your youngster’s diagnosis.

13. Know your youngster’s rights. As the mother or father of an HFA youngster, you have a legal right to: (a) seek an outside evaluation for your youngster; (b) request an IEP meeting at any time if you feel your youngster’s needs are not being met; (c) invite anyone you want—from a relative to your youngster’s physician—to be on the IEP team; (d) free or low-cost legal representation if you can’t come to an agreement with the school; (e) disagree with the school system’s recommendations; and (f) be involved in developing your youngster’s IEP from start to finish.

14. Learn as much as you can about High-Functioning Autism. The more you know about it, the better equipped you’ll be to make informed decisions for your youngster. Educate yourself about the treatment options, ask questions, and participate in all treatment decisions.

15. A youngster coping with High-Functioning Autism is still a kid. For both you and your child, there needs to be more to life than therapy. Schedule playtime when your youngster is most alert and awake. Figure out ways to have fun together by thinking about things that make your youngster smile, laugh, and come out of his shell. He is likely to enjoy these activities most if they don’t seem therapeutic or educational. There are tremendous benefits that result from your enjoyment of your youngster’s company – and from his enjoyment of spending un-pressured time with you.  Play is an essential part of learning and shouldn’t feel like work.

16. Pay attention to your youngster’s sensory sensitivities. Many kids with High-Functioning Autism are hypersensitive to light, sound, touch, taste, and smell. Other HFA kids are “under-sensitive” to sensory stimuli. Figure out what sights, sounds, smells, movements, and tactile sensations trigger your kid’s disruptive behaviors – and what elicits a positive response. What does she find stressful? Calming? Uncomfortable? Enjoyable? If you understand what affects her, you’ll be better at troubleshooting problems and preventing situations that cause difficulties.

17. Positive reinforcement can go a long way with HFA kids, so make an effort to “catch your child doing something good.” Praise him when he acts appropriately or learns a new skill, being very specific about what behavior he is being praised for. Also look for other ways to reward him for good behavior (e.g., giving him a sticker, letting him play with a favorite game, etc.).

18. Kids with High-Functioning Autism tend to do best when they have a highly-structured schedule or routine. They need and crave consistency. Set up a schedule with regular times for meals, therapy, school, and bedtime. Try to keep disruptions to this routine to a minimum. If there is an unavoidable schedule change, prepare your youngster for it in advance.


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
By

Students on the Autism Spectrum: Coping with the First Year of Public School

"My son with autism (high functioning) will be attending his first year of public school next year, and I am making early preparations now so he can be as successful as possible given the challenges.  He's already having a lot of anxiety even though it's about 8 months away. He's been home-schooled and this will be quite a change for him. I've heard that this transition is particularly stressful for children with this condition. How can I help him cope effectively with this big change coming up in his life?"

Your child with Asperger’s (AS) or High-Functioning Autism (HFA) will be starting his first year in the public school system — and as a parent, you may be very nervous.

Some AS and HFA children will start the year off easily, breezing into the classroom with a quick goodbye — but after a few days — cling as you try to leave.

Others will enter the building only under protest from day one. Then there are those who rush off to school with great enthusiasm, but have a meltdown the instant you pick them up.

Others may get stomachaches, or have difficulty falling asleep. Some may even experience going to school as a rejection, particularly if a younger sibling stays home with mom. These are the challenging, but frequent reactions to the start of school.

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism
  
First grade is an important year for most kids for many reasons. It is a big change from half-day kindergarten to all-day first grade. For some, it may be scary riding the school bus home with the older kids (not to mention the extended hours away from mom and dad).



To help parents ease their “special needs” children into the school experience, here are some practical tips for getting off to a good start. Tailor these techniques to suit you and your youngster:

1. Acknowledge your own separation anxiety. Moms and dads worry when their children start public school for the first time. They worry if the educators will really know how to care for their “special needs” youngster. They feel a sense of loss because this is usually the first time their youngster is away from home this long. They may also feel loss because they work full time and can’t be there at the school to help their youngster adjust to the new environment. They may feel guilty if they have to leave a crying youngster at school and go off to work. So, as a parent, try too can find ways to work things through by talking with a friend, spouse, school guidance counselor, or pastor if needed.

2. Adjust your child’s lunch schedule to his school’s timing. Contact the school to find out when your youngster will be eating lunch. A youngster who is used to eating at 11 a.m. can get hungry if their scheduled lunchtime isn’t until noon.

3. Ask the school for help if your youngster has trouble adjusting. If separation remains stressful after a few weeks, set up a meeting with your youngster’s educator and the school’s guidance counselor to speak about the best ways everyone can help you adjust. If possible, meet without your youngster – or you may want to schedule a separate meeting with your youngster present so everyone can make a plan together.

4. Ask the educator for help. If your youngster won’t let you go, turn to the educator for assistance. She probably has a lot of experience with this. You might say, “Let’s go say hello to Miss Johnson together. She will take good care of you.”

5. Ask your youngster a few compelling questions. Specific questions will help your youngster imagine what school will be like and help you talk about the fun stuff and the hard stuff. You could ask, “Is there anything that worries you about starting school?” … “What are you really looking forward to?” … “What do you think the hardest part of school is going to be?” …and so on.

6. Attend school events. Go to “Back-to-School night’ and PTA meetings. These events give you the opportunity to see the world your youngster lives in every day – and meet the adults in charge (as well as other moms and dads).

7. Create a home environment that allows after-school downtime and sharing. Whether you pick your child up at school or she arrives home on a bus, a youngster coming home from a full-day of school will most likely be very hungry and needing to relax. Don’t try to ‘talk’ about your child’s day until you have her basic needs met (e.g., snacks and rest). Allow your child some time to play outside or in her room before talking about her day. But then, whether during dinner or at bedtime, allow her to unload. Right before bedtime may be the best time to talk. Kids seem to be an open book at that time of night.

8. Describe what will happen on the first day. Keep in mind that an AS or HFA youngster starting school for the first time may have a hard time imagining what it will be like. Talking about the basic sequence of the day will help your youngster make a mental movie of what to expect. AS and HFA children form pictures in their minds, and reviewing the process in detail will make things more familiar and less scary on the first day of school.

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

9. Don’t be surprised if your youngster is upset at the end of the day. AS and HFA children often save up their hard feelings for their mom or dad, because it feels safer to let these feelings out at home than at school. It’s actually a good thing when children save up their hard feelings for their care-takers. You can even expect a surge in sibling rivalry or fighting with YOU at home. Children don’t usually come home and say, “Things got rough on the playground today,” but they often act-out their feelings at home.

10. Don’t talk about how much you will miss your youngster. Don’t let your own worries get in the way. Walk your youngster into school (or put him on the school bus), and then talk to other moms and dads if you need support. Your youngster has enough to worry about on the first day without soothing your worries.

11. First grade moms and dads can best help their “special needs” kids weather what can be a bumpy year by focusing on making sure the youngster has a solid, familiar routine that allows her to get enough sleep, play out of doors, bathe, keep her room tidy, and practice any skills or hobbies in which she has taken an interest.  The need for a solid night’s rest at this age can’t be over-stated.  Kids of this age need approximately 10 hours of sleep.  Every good day starts with a good night of sleep (a sound piece of advice, not just for first-graders, but their exhausted mom and dad as well).

12. Help your youngster allay feelings of frustration at not being able to do things exactly right the first time by reminding her of all the things she is able to do this year that she could not do the year before (e.g., ride a bike, help with the dishes, read all by herself, etc.). 

13. Focus on fun. If you escort your youngster to school, check out the playground before you go in. Meet the educator together and take a look around the new classroom for things you know your child enjoys (e.g., art supplies, a fish tank, the reading corner, etc.).

14. Get to know the educator. The faster you can establish a positive relationship with your youngster’s educator, the faster your youngster will adjust to the new surroundings and become independent. The safer your youngster feels, the more energy he can put into learning. So from a parent’s perspective, you want to support your youngster forming a strong bond with his educator(s).

15. Get up early. When you do, you can have a relaxed breakfast, leave enough time to deal with upsets, and still get to school on time.

16. Give your child control over what he can control. Offering simple choices may help calm nerves and get your child excited. For instance, if you pick out a new backpack or lunchbox, let your youngster choose the color. If you shop for school supplies, let your youngster find the items in the store and check them off on your list. The day before school starts, let your youngster choose clothes for the first day (but keep veto power).

17. If your youngster gets upset, acknowledge the feeling and ask him for suggestions. You can say, “I know you’re upset. I’m sure other children are too. Let’s think about what will help you feel better.” Suggest reading a book together or starting an activity.

18. If your youngster misses you a lot, choose a special object together that he can bring to school. Sometimes it helps with the transition if children can bring a memento from home (e.g., a parent’s picture, a note, a scarf, or other special object to remind them that their mom and dad are thinking of them). Encourage your youngster to show the object to the educator (inquire to see if there is a policy about how your youngster can use the object during the school day).

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

19. If your youngster says, “I don’t want to go,” remind her about the fun things. Think of something you know your youngster loves to do, or likes about school. See if you can get started on this activity together. Remind your youngster of all the new (or old) friends in her class, and go over and say hello together. If you don’t take your youngster to school, suggest she do some of these activities when she gets there, and send a note to the educator about your concerns.




20. If your youngster says, “I hate school,” ask him what’s wrong about it. Children will usually be able to tell you exactly what’s wrong. It’s common for kids to worry about playing on the playground with bigger peers, or about when dad will return for pick up. Help your youngster develop a solution to the problem. You can ask, “What makes the playground feel frightening?” Talk to the educator (with your youngster) about it. Ask your youngster if he wants to tell the educator himself, or would like you to do it.

21. If your youngster takes the school bus, encourage him to make “bus friends.” Get to know other moms and dads at the bus stop to help you feel connected to school, and to help your youngster find friends. Create your own special goodbye ritual to send your youngster off with a good feeling.

22. Learn about the drop-off policy. Find out about the policy for walking kids into the classroom and how long you can stay. If you anticipate that your youngster will need extra time to adjust, talk to the educator before school starts.

23. Pretend to be the educator of your child’s first grade class. Do some role-plays. This may help remove some of the fear of what to expect.

24. Look around the classroom. If you drop your youngster off in the classroom, look around to see what is changing every day. What’s new on the walls? Which books are in the book corner? Noticing the details may help you reconnect with your youngster later and talk about them together.

25. Make a quick exit. Take your cue from the educator and from your youngster, but when it’s time to go – LEAVE! A swift exit may be more useful to your youngster than a drawn-out goodbye. You can often call school later to check on how your son or daughter is doing (and you’ll probably find out that he or she is doing fine).

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

 26. Meet other children in the class. Find out if there will be a class gathering before the first day. It can be helpful to see familiar faces when your child walks into a new classroom. Even if your youngster already has friends at school, schedule some play dates with children your youngster may not have seen over the summer.

27. Plan ahead how you will say goodbye. Think about what your youngster needs in a goodbye. What will be most helpful (e.g., a quick goodbye, five minutes of cuddle time, etc.).

28. Practice going to school. Make a dry run to help your youngster get familiar with the route and the routine. Point out interesting sights or places familiar to your youngster. Notice the swings, slides, or other fun things that your think your youngster will like, and try them out together.

29. Practice patience. The first week of “full-day school’ may be a big shock for the entire family, but be patient. The tiredness and grumpiness may linger beyond that first week. It usually takes much longer (usually around Christmas break) for AS and HFA children to get accustomed to their schedule. And it may take the entire family a good month to get into the groove of the new school year.

30. Practice the school routine prior to school starting. To help your youngster adjust, plan to shift her schedule from summer to school mode before school starts. Routine, especially at home, is so important. Start the “early-to-bed routine” several days before school starts in the summer to get your child used to it. In this way, it won’t be a shock.

31. Read books about starting school. Books will get children talking and feeling comfortable. Some good ones include:
  • “Annabelle Swift, Kindergartner” by Amy Schwartz
  • “First Day Jitters” by Julie Dannenberg
  • “Get Ready for Second Grade, Amber Brown” by Paula Danzinger
  • “I Am Absolutely Too Small for School” by Lauren Youngster
  • “The Berenstain Bears Go to School” by Stan and Jan Berenstain

32. Reduce morning stress on school days. Reducing stress in the morning can help make the whole day turn out better. Be sure to lay out school clothes at night and give your youngster plenty of time to eat a healthy breakfast. Helping her with her morning routines can prevent stress too. Give your child a pictorial checklist. You can download great pictures to match her list of things to do (down to the exact backpack she will be heading off to school with).

33. Refresh and encourage your youngster while he is at school. Even though you can’t attend school alongside your youngster, don’t underestimate the value of a note or other reminder in his lunchbox. Missing mom and dad can be a real concern. Family photos can be a reminder for the non-readers that their parents will be waiting for them at the end of the day. Whether it’s a photo taped in a lunchbox or a small photo on a yarn necklace, it can be a real comfort.

34. Remember what school was like for you. What you think school will be like for your youngster is likely based on what school was like for you. Thus, it’s important to recognize that your youngster may have a very different experience than you did. Separate your own feelings about school from your childhood so your son or daughter can have a fresh start. You may have had a horrible experience, which can make you over-worry about your child. You may have had a wonderful experience, which could make you insensitive to places where your child may be having a hard time. This is why thinking about and separating-out your own experience is so important.

35. Talk about school at home. Specific questions might get your child talking. For example, "What did you do on the playground today?” … “What was the best part of the story the teacher read today?” … “What’s it like to be line-leader?” … and so on. You don’t need to be there to learn about what your youngster does at school. Discuss what the educator writes in the newsletter. When your youngster brings home work, comment on it with specifics.

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

36. Understand your role in the separation process. Your separation issues could be feeding your youngster’s anxiety. If you are having trouble separating, your youngster will always pick this up. One way to help you both feel better is by developing a trusting relationship with the educator.

37. When school starts, let your youngster wear a special locket with a picture of someone special in it. It is comforting to know you have someone you love close to you. If your youngster brings her lunch to school, put a red paper heart in it.

38.  When you take your youngster into his classroom, ask to see some work. If you sense your youngster feels uneasy at drop off, focus on the positive. Ask him to show you an art project or other activity he’s doing at school.

39. One way to help make this “new challenge” go a little smoother is to buy supplies ahead of time. Here is a checklist of a few common things that first graders use: 
  • 1 box of tissues
  • 1 composition notebook
  • 1 package dry erase markers (low odor)
  • 1 package large Crayola™ water colored markers (8 in a box)
  • 1 plastic folder with pockets
  • 12 large glue sticks
  • 2 boxes crayons (24 or less)
  • 2 erasers (plain)
  • Fiskars™ metal scissors (they also have left handed scissors)
  • plain pencils (40 sharpened)
  • school box (plastic, not to exceed 3" in height)

40. If your efforts (as outlined above) don’t seem to be working – be flexible. Adjust routines if needed. Is your child getting enough sleep, food, recreation, etc.? Is there anything else going on at school (e.g., bullying)? By maintaining your patience, you will help ease the transition to full-day school for your youngster, and perhaps just as important, yourself.

Little things can make a big difference in how AS and HFA kids will adjust to change. First grade is the beginning of many important changes in your child’s life. Taking the time to ensure an easy transition for all involved is a smart investment.


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... I homeschool. Society is far too cruel and nowhere near ready for our advanced children!
•    Anonymous said... I put my son in catholic school. We have had no issues. They are patient and kind and the other children and very understanding. Summer camp with public school kids...didn't go as well. I would also put my son in a Friends school if we could swing it. No public school for us!
•    Anonymous said... my boy was homeschooled till 3rd grade...now it's very hard due to kids being mean to him ...he just needs a lot of help & the schools special ed plan is very good .mostly it's my boy's reaction to his peers that bring on more stress .He does have a few friends that get him so that is helpful...
•    Anonymous said... my son, 12, just began middle school, and is in a small group of kids, and was excited to get his first locker! He's in a good supportive school.
•    Anonymous said... We began homeschooling this year (third grade) due to issues with the school system.

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The Basics of Teaching Young Students on the Autism Spectrum

“What advice would you have regarding the most effective teaching methods for young students on the high end of the autism spectrum? I have two ASD students in my class this year (twin brothers).”

First of all, you need to know that Asperger’s (AS) – also referred to as High-Functioning Autism (HFA) – is an autism “spectrum” disorder (i.e., affected children have significantly different abilities and limitations). Before you can prepare for an AS or HFA child in your classroom, you should develop an understanding of the specific child's needs. Prior to the first day of school, review the child's records and look for notes from previous educators that indicate his abilities. Speak to the child's mom and dad and ask them what they feel their son might need to be successful. Meet with the child on the first day of class to become familiar with him and gather information about his needs.



Let’s go into greater detail about the specifics of teaching students on the autism spectrum:

1. Address the AS/HFA student individually at all times (e.g., he may not realize that an instruction given to the whole class also includes him). Calling the student’s name and saying, “I need you to listen to this because this is something for you to do” can sometimes work. Other times, the student will need to be addressed individually.

2. Allow some access to obsessive behavior as a reward for positive efforts.

3. Allowing the student to avoid certain activities (e.g., sports and games) which he may not understand or like. Also, support the student in open-ended and group tasks.

4. Always keep your language simple and concrete. Get your point across in as few words as possible. Typically, it’s far more effective to say, “Pencils down, close your books, and line up for lunch” rather than, “It’s almost time for lunch. Quickly finish your Math assignment. As soon as you’ve finished, close your books and line up at the door. Then after lunch, we’re going outside to study some plants.”

5. AS and HFA kids commonly become fixated on objects. At times, these fixations can draw the child's attention away from classwork. To avoid problems caused by fixation, educators can use the youngster’s fixations as a motivational tool. Seek to link work to the student’s particular interests. For instance, if the child loves reading picture books about trains, gather a large selection of books that fall into this category, and allow the child to read these books only after he has completed his classwork. The desire to return to his train books will encourage the child to stay focused on the task at hand and move through the necessary activities.

6. AS and HFA children are commonly visual learners. Use images whenever possible to assist the child in understanding material. Pairing vocabulary words or other lesson concepts with diagrams or images gives the youngster a visual reference and allows him to commit the information to memory more easily.

7. Avoid over-stimulation. Minimize distractions and provide access to an individual work area when a task involving concentration is given. Colorful wall displays can be distracting for some AS and HFA students. Others may find noise very difficult to cope with.

8. Avoid the use of idioms (e.g., “put your thinking caps on” … “open your ears” … “zip your lips” …etc.). These will leave an AS/HFA child completely mystified and wondering how to do that.

9. Avoid the use of sarcasm. If the child accidentally knocks all your paperwork on the floor and you say, “That’s just great!” …you will be taken literally, and this action might be repeated on a regular basis.

10. Be aware that normal levels of auditory and visual input can be perceived by the AS/HFA child as too much or too little (e.g., the hum of fluorescent lighting is extremely distracting for most children on the spectrum). Consider environmental changes like removing some of the "visual clutter" from the room or seating changes if the child seems distracted or upset by the classroom environment.

11. Don't take “misbehavior” personally. The high-functioning student is not a manipulative, scheming child who is trying to make life difficult for you. Usually misbehavior is the result of efforts to survive experiences which may be confusing, disorienting, or scary. Recognize that the target for the student’s anger may be unrelated to the source of that anger. AS and HFA children are, by virtue of their disorder, egocentric and have extreme difficulty reading the reactions of others. They are literally incapable of being manipulative.

12. Exploring word-processing, and computer-based learning for literacy.


13. Give fewer choices. For example, if the AS/HFA youngster is asked to pick a color, only give him two to three choices to pick from. The more choices, the more confused the youngster will become.

14. Give very clear choices, and try not to leave choices open-ended. You’ll get a better result by asking, “Do you want to practice writing, or do you want to read a book?” …than by asking “What do you want to do next?”

15. If you ask a question or give an instruction and are greeted with a blank stare, re-word your sentence. Asking the child what you just said helps clarify that you’ve been understood.

16. If your class involves pairing-off or choosing partners, either draw numbers or use some other arbitrary means of pairing. You can also ask an especially kind child if she would agree to choose the AS/HFA peer as a partner. This should be arranged before the pairing is done. The child with AS or HFA is most often the person left with no partners. This is unfortunate since these children could benefit most from having a partner.

17. If the high-functioning child uses repetitive verbal arguments or repetitive verbal questions, try requesting that he write down the question or argumentative statement. Then write down your reply. As the writing continues, the AS/HFA youngster usually begins to calm down and stop the repetitive activity.

18. One of the hallmarks of AS and HFA is the affected child’s general detachment and unwillingness to engage in social behavior. Attempts to force the child to complete cooperative activities will likely fail. Instead offer (but don't require) interactive activities. Pushing the youngster to interact with his fellow students will only cause him to detach even more (and may lead to academic struggles).

19. Many schools practice inclusion, which combines AS and HFA children in the same classroom as “typical” children. The idea is that the child on the autism spectrum learns faster and adapts appropriate social behavior by observing his fellow classmates. Peer-tutoring is a one-to-one teaching method often practiced in inclusion schools. In a structured environment, the “typical” child leads the AS/HFA child through a number of tasks with brief instructions.

20. Protect the AS/HFA student from teasing at free times, and provide his classmates with some awareness of his particular needs.





21. Provide a very clear structure and a set daily routine, including time for play.

22. Provide a warning of any impending change of routine, or switch of activity.

23. Understand that some change in the AS/HFA student’s behavior or attitude may reflect anxiety, which may be triggered by even a minor change to routine.

24.  Teach specific social rules and skills (e.g., turn-taking, social distance).

25. Teach what “finished” means, and help the child to identify when something has finished and something different has started. Take a photo of what you want the finished product to look like and show the child. For example, if you want the room cleaned up, take a picture of how you want it to look some time when it is clean. The child can use this for a reference.

26. Daily routines should remain the same. There should be no surprises for AS and HFA kids. Use pictures for depicting the classroom schedule. By using pictures that represent a particular activity, the youngster is well aware of what is going to be taught next. If everything becomes predictable for the AS/HFA student, he is able to learn and concentrate more.

27. The curriculum should be planned in such a way that it incorporates the “daily living skills” which will help the AS/HFA youngster to work independently as a grown-up, for instance:
  • hobbies according to the interest of the youngster
  • money skills
  • reading skills
  • self-care skills
  • skills related to employment
  • social behavioral skills
  • social skills
  • time management skills
  • writing skills

28. The classroom environment where the AS/HFA youngster is going to be taught should be very plain, calm and quiet. Avoid putting colorful charts and posters on the walls. Lots of colors often distract the youngster, making it difficult to concentrate. Also, select a particular spot for extra activities. For instance, if you have chosen the space near the back of the room for doing art activities, keep it like that and don't change it. By doing this, the moment you ask the youngster to sit in the back, he will know that it is time for art class.

29. Use “task analysis” (i.e., very specific tasks in sequential order).

30. Using various means of presentation (e.g., visual, physical guidance, peer-modeling, and so on).

Educating a youngster on the autism spectrum can be quite challenging. But, with proper planning and patience, anybody – whether a student aide, teacher, school counselor or principal – can face this challenge.


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... Organize, organize, organize. As a parent and teacher, I found a chart with the week's homework to write in agenda, daily schedule, competition, group work, everything having its place with binders, pencil boxes (no messy desk), possibly a clock or large timer with count down. Direct language and fair, logical is very important. Don't move the goal post. May not be able to relate one bad behavior with another, so each may need to be explained, then held accountable. Showing progress through percentages. Each kid is different, but once you are able figure what focuses them, they can be great students. Good luck.
•    Anonymous said... http://www.myaspergerschild.com/2013/08/aspergers-and-high-functioning-autism.html ...This is the best, concise Fact Sheet I have found. I used it last year, and plan to this year. Thank you so much for making this available. It can help with anyone in authority that helps with your child. IE, coaches, Pastors, Other Parents, etc. Thanks.
•    Anonymous said... 1. Keep in mind that autism affects every person with it differently. Each of those kids could have very different strengths and weaknesses. 2. That being said, visual schedules, reminders before transitions to new activities, and extra organizational help will probably be beneficial for both. Be literal and direct with directions, and take the time to explain things to them when others aren't. Turns of phrase and colloquialisms can be confusing for people with autism. It may also be beneficial to speak with the parents of the students about any sensory sensativites they may have, and for what they usually do to work around them. (Earplugs for hypersensative hearing, or a textured cusion to help with sitting still in their seat, ect.) Good luck this coming school year.

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