“If we had to choose only one, what would be the best intervention strategy for our child with HFA?”
For most children with High-Functioning Autism (HFA) and Asperger’s (AS), the most important treatment strategy would definitely be to enhance communication and social competence (i.e., social skills training).
The goal is not to force the child to “conform to societal pressure” or to stifle individuality and uniqueness. Instead, the goal reflects the fact that most kids on the autism spectrum are not loners by choice.
Also, there is a tendency (as these kids develop towards the teenage years) for anxiety, depression, despondency, and negativism as a result of the child’s increasing awareness of personal inadequacy in social situations, and repeated experiences of failure to make and maintain relationships.
The typical limitations of insight and self-reflection found in kids on the spectrum often prevent spontaneous self-adjustment to social and interpersonal demands. Social skills training prepares the “special needs” child to cope with social and interpersonal expectations, therefore enhancing his or her attractiveness as a conversational partner or as a potential friend or companion.
The following are suggestions intended to foster relevant skills in this crucial area:
1. The HFA or AS child should be taught to monitor his own speech style in terms of the following:
adjusting depending on proximity to the speaker
context and social situation
naturalness
number of people and background noise
rhythm
volume
2. Through verbal means, the child should be helped to recognize and use a range of different means to:
disagree
discuss
interact
mediate
negotiate
persuade
3. In order to increase the flexibility with which the child both thinks about - and uses language with - other people, it is be important to help the him or her to:
anticipate multiple outcomes
develop the ability to make inferences
explain motivation
predict
4. The effort to develop the HFA or AS child’s skills with peers in terms of managing social situations should be a priority. This should include:
ending topics appropriately
feeling comfortable with a range of topics that are typically discussed by same-age peers
shifting topics
the ability to expand and elaborate on a range of different topics initiated by others
topic management
5. Explicit verbal instructions on how to interpret other people's social behavior should be taught in a fashion not unlike the teaching of a foreign language (i.e., rote fashion; all elements should be made verbally explicit and appropriately and repeatedly drilled). For example:
facial and hand gestures
gaze
non-literal communications such as humor, figurative language, irony, sarcasm and metaphor
the meaning of eye contact
tone of voice
various inflections
6. The same principles should guide the training of the child’s expressive skills. Concrete situations should be exercised and gradually tried out in naturally occurring situations. All those in close contact with the child (teachers, coaches, etc.) should be made aware of the program so that consistency, monitoring and contingent reinforcement are maximized.
7. Encounters with unfamiliar people (e.g., making acquaintances) should be rehearsed until the child is made aware of the impact of her behavior on others’ reactions to her. Strategies include:
“We are wanting to get our child (high functioning) into some form of therapy. What things should we look for so we can find the best fit for her specific needs?”
The following are positive program specifications to be kept in mind when deciding on an appropriate program for children with High-Functioning Autism (HFA). These may not be applicable to every child; however, they are optimal conditions to keep in mind when dealing with program specifications.
Ideally, the program will include the following:
1. Opportunities for social interaction and facilitation of social relationships in fairly structured and supervised activities.
2. Relatively small setting with ample opportunity for individual attention, individualized approach, and small work groups.
3. The availability of a communication specialist with a specific interest in pragmatics and social skills training who can (a) be available for individual and small group work, and (b) make a communication and social skills training intervention an integral part of all activities. These activities should be implemented at all times, consistently, and across staff members, settings, and situations. This specialist can also act as a resource to the other staff members.
4. A concern for the acquisition of real-life skills and academic goals, making use of creative initiatives and making full use of the child’s interests and talents. For instance, given the fact that children with HFA often excel in certain activities, social situations may be constructed so as to allow him the opportunity to take the leadership in the activity, explaining, demonstrating, or teaching others how to improve in the particular activity.
Such situations are ideal to help kids on the autism spectrum:
Follow coherent and less one-sided goal-directed behaviors and approaches. Also, by taking the leadership in an activity, the child’s self-esteem is likely to be boosted, and her (usually difficult) position vis-a-vis peers is for once reversed.
Follow conversation and social interaction rules.
Take the perspective of others.
5. The availability of a sensitive therapist who can focus on the youngster’s emotional well-being and who could serve as a coordinator of services, serving as a resource to other staff members, monitoring progress, and providing effective and supportive liaison with the family.
6. Lastly, a willingness to adapt the curriculum content and requirements in order to flexibly provide opportunities for success, to foster the acquisition of a more positive self-concept, and to foster an internalized investment in performance and progress. This may mean that the child with HFA is provided with individual challenges in his or her areas of strength, and with individualized programs in his or her areas of weakness.
Resources for parents of children and teens on the autism spectrum:
The best treatment for Asperger's and high-functioning autistic children and teens is definitely “social skills training.” Social skills training is a form of behavior therapy used by therapists to help these "special needs" young people who have difficulties relating to other people. But, parents can teach social skills as well. It's especially easy to do so with the help of social skills DVDs and CDs.
“I have an autistic student (level 1, high functioning) in my 5th grade class this year and was needing to know if there are any communication impairments associated with the condition that I should be aware of. Thanks in advance.”
Although significant problems with speech are not typical of High-Functioning Autism (HFA), there are at least 4 features of these students’ communication skills that should be understood.
1. Though inflection and intonation are not be as rigid and monotonic as in classic autism, speech is often marked by poor prosody (i.e., patterns of stress and intonation). Young people with HFA often have an odd manner of speaking (e.g., words enunciated precisely and formally; the speed, volume and rhythm may be strange).
Problem areas to look out for include talking loudly, odd rhythms of speech, stilted or formal speech, monotonous sound, little or no inflection, and difficulties in coordinating speaking and breathing.
2. Speech is often vague and circumstantial, conveying a sense of looseness of associations and disjointedness. The lack of coherence and reciprocity in speech is a result of (a) the one-sided, egocentric conversational style (e.g., endless monologues about the names, codes, names of dinosaurs, etc.), and (b) failure to provide the background for comments and to clearly establish changes in topic.
3. Another aspect typifying the communication patterns of children with HFA concerns the significant verbosity observed (which some researchers see as one of the most prominent traits of HFA). The youngster may talk incessantly (usually about his or her favorite topic) with complete disregard to whether the listener is interested, engaged, attempting to interject a comment, or change the subject of conversation.
Despite such long-winded monologues, the child may never come to a point or conclusion. Attempts by peers to elaborate on issues of content or to shift the conversation to related topics are usually unsuccessful.
4. The possibility exists that all of these traits may be accounted for in terms of significant deficits in pragmatics skills and/or lack of awareness of other people's expectations. Pragmatics refers to language usage and the way that context relates to meaning. Kids on the autism spectrum often have difficulty in holding a normal conversation where there is “give and take” in the social interaction.
Problems with pragmatics manifest in a number of ways, including when the child is oblivious to emotional reactions in others, is oblivious to boredom in others, does not greet others and instead jumps right into a monologue, lacks facial expression and eye contact, interrupts others, gives too much detailed information, focuses exclusively on topics that interest him or her, does not use people’s names, and does not allow the other person to talk.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
"How does one tell the difference between meltdowns and temper tantrums in a child with ASD level 1? I certainly do not want to punish my son for something he cannot control."
ASD level 1 or High-Functioning Autism is a neurological condition. The brain is wired differently, making this disorder a lifelong condition. It affects communication, social interaction and sensory issues. ASD is often referred to as the "invisible syndrome" because of the internal struggles these kids have without outwardly demonstrating any real noticeable symptoms. Thus, difficultly assessing someone with the disorder is even more impacted.
Kids with this disorder struggle with a problem and internalize their feelings until their emotions boil over, leading to a complete meltdown. These outbursts are not a typical temper tantrum. For children on the autism spectrum (and for their parents), these episodes are much worse.
Many of these kids may appear under-receptive or over-receptive to sensory stimulation and therefore may be suspected of having vision or hearing problems. Therefore, it's not unusual for parents or teachers to recommend hearing and vision tests. Some kids may avoid gentle physical contact such as hugs, yet they react positively to rough-and-tumble games. Some kids on the spectrum have a high pain tolerance, yet they may not like to walk barefoot in grass.
There are nine different types of temperaments in ASD children:
Distractible temperament predisposes the child to pay more attention to his or her surroundings than to the caregiver.
High intensity level temperament moves the child to yell, scream, or hit hard when feeling threatened.
Hyperactive temperament predisposes the child to respond with fine- or gross-motor activity.
Initial withdrawal temperament is found when children get clingy, shy, and unresponsive in new situations and around unfamiliar people.
Irregular temperament moves the child to escape the source of stress by needing to eat, drink, sleep, or use the bathroom at irregular times when he or she does not really have the need.
Low sensory threshold temperament is evident when the child complains about tight clothes and people staring and refuses to be touched by others.
Negative mood temperament is found when children appear lethargic, sad, and lack the energy to perform a task.
Negative persistent temperament is seen when the child seems stuck in his or her whining and complaining.
Poor adaptability temperament shows itself when children resist, shut down, and become passive-aggressive when asked to change activities.
Some meltdowns are worse than others, but all leave both parent and kid exhausted. Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it ends, both you and the autistic child are totally exhausted. But… don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day, and sometimes into the next, the meltdown can return full force.
Meltdowns are overwhelming emotions and quite common in kids on the spectrum. What causes them? It can be anything from a very minor incident to something more traumatic. How long do they last? It’s anyone’s guess. They last until the kid is either completely exhausted, or he gains control of his emotions, which is not easy for him to do.
If your youngster has to find ways to cope with the disorder, expect her to experience both minor and major meltdowns over incidents that are part of daily life. She may have a major meltdown over a very small incident, or may experience a minor meltdown over something that is major. There is no way of telling how she is going to react about certain situations. However, there are some ways to help your kid learn to control his emotions.
ASD children don’t really have the knowledge to decipher when their actions are inappropriate. When your kid is calm and relaxed, talk to her about her meltdowns if she is of an age where she can reason and learn to work with you. This will probably not be until the kid is seven or eight years old. Then, tell her that sometimes she does things that are not appropriate. Have her talk to you about a sign you can give her to let her know when this happens.
All you can do is be patient with your kid while she is having a meltdown, though they are emotionally exhausting for you as well as he. Never punish her for experiencing a meltdown. Overwhelming emotions are part of the traits associated with the disorder, but if you work with your kid, she will eventually learn to control them somewhat.
These young people don’t like surprises and some don’t like to be touched. Never rush to your youngster and give her a hug. If you want to hug her, tell her exactly what you are going to do. A surprise hug can send her into an even worse meltdown than she is already experiencing.
ASD kids like to be left alone to cope with emotions. If your kid says something like, “I just want to be left alone,” respect her wishes for at least a while. You can always go back in ten minutes and ask if you can help. Do not be hurt if she refuses.
Work with your youngster as she grows older to help her learn to cope with daily life. Remember, she sees the world much differently than we do and needs help deciphering exactly how we see the world. While working with her on this, she will give you clues as to how she sees the world and a firmer bond will be established.
It is much easier to prevent meltdowns than it is to manage them once they have erupted. Here are some tips for preventing meltdowns and some things you can say:
Avoid boredom. Say, “You have been working for a long time. Let’s take a break and do something fun.”
Change environments, thus removing the child from the source of the meltdown. Say, “Let’s go for a walk.”
Choose your battles. Teach children how to make a request without a meltdown and then honor the request. Say, “Try asking for that toy nicely and I’ll get it for you.”
Create a safe environment that children can explore without getting into trouble. Childproof your home or classroom so children can explore safely.
Distract children by redirection to another activity when they begin to meltdown over something they should not do or cannot have. Say, “Let’s read a book together.”
Do not ask children to do something when they must do what you ask. Do not ask, “Would you like to eat now?” Say, “It’s suppertime now.”
Establish routines and traditions that add structure. For teachers, start class with a sharing time and opportunity for interaction.
Give children control over little things whenever possible by giving choices. A little bit of power given to the child can stave off the big power struggles later. “Which do you want to do first, brush your teeth or put on your pajamas?”
Increase your tolerance level. Are you available to meet the child’s reasonable needs? Evaluate how many times you say, “No.” Avoid fighting over minor things.
Keep a sense of humor to divert the child’s attention and surprise the child out of the meltdown.
Keep off-limit objects out of sight and therefore out of mind. In an art activity keep the scissors out of reach if children are not ready to use them safely.
Make sure that children are well rested and fed in situations in which a meltdown is a likely possibility. Say, “Supper is almost ready, here’s a cracker for now.”
Provide pre-academic, behavioral, and social challenges that are at the child’s developmental level so that the child does not become frustrated.
Reward children for positive attention rather than negative attention. During situations when they are prone to meltdowns, catch them when they are being good and say such things as, “Nice job sharing with your friend.”
Signal children before you reach the end of an activity so that they can get prepared for the transition. Say, “When the timer goes off 5 minutes from now it will be time to turn off the TV and go to bed.”
When visiting new places or unfamiliar people explain to the child beforehand what to expect. Say, “Stay with your assigned buddy in the museum.”
There are a number of ways to handle a meltdown once it has started. Strategies include the following:
When possible, hold the child who is out of control and is going to hurt himself or herself or someone else. Let the child know that you will let him or her go as soon as he or she calms down. Reassure the child that everything will be all right, and help the child calm down. Parents may need to hug their child who is crying, and say they will always love him or her no matter what, but that the behavior has to change. This reassurance can be comforting for a child who may be afraid because he or she lost control.
If the child has escalated the meltdown to the point where you are not able to intervene in the ways described above, then you may need to direct the child to time-away (not to punish, but to remove the child from the current environment!). If you are in a public place, carry your child outside or to the car. Tell the child that you will go home unless he or she calms down. In school, warn the child up to three times that it is necessary to calm down and give a reminder of the rule. If the child refuses to comply, then place him or her in time-away for no more than 1 minute for each year of age (again, not to punish, but to remove the child from the current environment).
Remain calm and do not argue with the child. Before you manage the child, you must manage your own behavior. Spanking or yelling at the child will make the meltdown worse.
Talk with the child after the child has calmed down. When the child stops crying, talk about the frustration the child has experienced. Try to help solve the problem if possible. For the future, teach the child new skills to help avoid meltdowns such as how to ask appropriately for help and how to signal a parent or teacher that the he or she knows they need to go to “time away” to “stop, think, and make a plan.” Teach the child how to try a more successful way of interacting with a peer or sibling, how to express his or her feelings with words and recognize the feelings of others without hitting and screaming.
Think before you act. Count to 10 and then think about the source of the child’s frustration, this child’s characteristic temperamental response to stress (e.g., hyperactivity, distractibility, moodiness), and the predictable steps in the escalation of the meltdown.
Try to intervene before the child is out of control. Get down at the child’s eye level and say, “You are starting to get revved up, slow down.” Now you have several choices of intervention.
Unlike a meltdown, you can ignore a tantrum if it is being thrown to get your attention. Once the child calms down, give the attention that is desired.
You can place the child in time away. Time away is a quiet place where the child goes to calm down, think about what he or she needs to do, and, with your help, make a plan to change the behavior.
You can positively distract the child by getting the child focused on something else that is an acceptable activity. For example, you might remove the unsafe item and replace with an age-appropriate toy.
Post-tantrum management:
Teach the child that anger is a feeling that we all have and then teach her ways to express anger constructively.
Never, under any circumstances, give-in to a temper tantrum. That response will only increase the number and frequency of the tantrums. Also, when an Asperger child has become accustomed to successfully manipulating parents with tantrums in the past -- but then doesn't get his way with today's tantrum -- it can often escalate into a meltdown. Now the parent has two distinctly different problems (that may look the same) to address.
Never let meltdowns interfere with your otherwise positive relationship with the child.
Explain to the child that there are better ways to get what he or she wants.
Do not reward the child after a meltdown for calming down. Some children will learn that a meltdown is a good way to get a treat later.
Resources for parents of children and teens on the autism spectrum:
