Thrive On the Autism Spectrum

DVD Review

How do you learn best? When working with clients, I find most of my clients are visual learners. That means supplementing our discussions with sketches and graphs and pictures can make things much clearer. Other people learn best experientially, in which case we might act things out and role play. A lot of people, myself included, love to learn by reading.  Many people, when first diagnosed, or when trying to understand a new phase in their lives, turn to book for ideas and answers. For you readers, I’ve got lots of book reviews on this blog. Then there are those individuals who are auditory processors. A lecture, a recording, a conference may be the best way for auditory processors to take in new material.

The four hour DVD set from Michelle Garcia Winner, Social Thinking Across the Home and School Day is an excellent resource for those who want something different than a book. The first two hours are a filmed lecture from Michelle Garcia Winner, where she presents her ideas in her typical clear, detailed, and easy to understand manner. The material is quite similar to what she presents in her books, but if you’d rather have the ideas clearly explained, this is a great resource. The second two hours demonstrates Garcia Winner with school age students, individually and in groups. Although Garcia Winner is demonstrating her social skills groups, the techniques and ideas can be useful to parents hoping to work with their children, as well as individuals trying to pick up these skills themselves. Often, people find that it can be tough to go from the theory about an idea to the application, and demonstrations like these may be just what it take to make these ideas clear.

These DVDs are designed for the parents of children on the spectrum, as well as teachers and professionals. Garcia Winner talks extensively about her communication model, as well as how a diagnosis such as Asperger’s or autism can impact learning as well as social relations. But there’s so little out there for adults on the spectrum, this material could be useful for adults as well. You can find the DVDs, as well as other materials on Michelle Garcia Winner’s Social Thinking website.

Should We Teach Children Scripted Responses?

There are several opinions about teaching children with special needs to use scripted social skills. For kids who struggle with reading and sending social messages, such as those with Asperger’s Disorder, Autistic Spectrum Disorders including Nonverbal Learning Disorder (NLD), as well as Attention Deficit Hyperactivity Disorder (ADD or ADHD), figuring out subtle messages can be much too challenging. A set of scripted, simple rules and guidelines may be useful in getting a general plan of action. (An example of a scripted response might be, “Say hello when you walk up to one person, but not when you enter the classroom.”) At the same time, trying to memorize and apply dozens of social rules can be overwhelming. It may even backfire because a person attempting to apply specific rules while in the midst of a confusing situation is not going to be able to focus on reading what’s going on. As is usually the case, I think the optimal answer lies somewhere in the middle.

Ideally, parents, teachers and therapists should be helping children figure out how to read social cues and how to naturally respond to them. This may accomplished in a completely organic way, with a parent getting a “hello” back from an engaged baby. In more difficult situations, trained adults can be working deliberately to engage the child and get a natural response. This is similar to techniques that might be used in Dr. Stanley Greenspan’s DIR® and Floortime™ model.

Setting up frequent playdates gives the child the opportunity to interact frequently with peers and may be a way to give practice in reading and responding to social cues in a natural and unscripted manner. This can be tricky because kids who are socially skilled are probably not going to adapt their interactions to be less subtle or more engaging in order to interact with a child who is struggling. Too often the socially skilled children will just stop playing with, or worse, start teasing or excluding the less skilled children. 

Playdates with two or more children who are all struggling socially may be the best choice for allowing friendships to develop and social skills to grow. This situation is not without its challenges. Some degree of adult involvement may be necessary in order to ease the relationship. For example, initiating a playdate may be the most challenging step. Teachers and parents may have to help set up the initial connection. While the children are playing, it may be necessary to have an adult present to help all the children interact smoothly. Because all the children may struggle to both read and send signals, the interactions can be difficult for everyone. When all goes well, the children can develop truly deep and important friendships that move beyond the more formal playdate setting. In addition, the skills are learned in a realistic way, so the problems with generalizing lessons to a different setting don’t occur.

When more natural interactions with adults and peers are not effective, then formal, scripted skills may be helpful. I view these scripts and rules as a way to ease into more ordinary, real-life interactions. An example of this might be a teacher prompting a shy child on how to approach a classmate, so they can sit together for lunch. Here, the most productive interactions will occur when the kids are eating and talking together without the teacher, but the more formal rules will help the child get to that point.

This example really illustrates the ideal situation. Allow the child to have as many natural and rewarding interactions with others, both children and adults, as possible. Use more formal social skills training to ensure that these natural interactions can take place and that they run smoothly. Take the time to analyze and understand the subtleties, and more important, set up a plan to make the interactions more productive next time.

Too Much Information

A frequent issue for those struggling with social skills is the question of how much to share. How long should your answer to the question last? How many reasons should you give if you’re late? What private information should you share with others?

Of course, the answer, as always, is that it depends. But, I not going to leave you with that. There are basic rules, and clues that you can read. For example, a standard answering machine message is set to record a standard message. If you always run to the end of the time limit, that’s a good clue that you’re talking too long. A voice mail or answering machine is set up to take basic information. Your name, your number, a brief reason why you’re calling. Maybe, to make life easy for the other end, you can repeat your name and number. Don’t give a bunch of reasons, don’t share all the details, don’t have the conversation without the other end there to listen.

It’s the same with emails. Take a look at a series of back and forth email correspondence. Is your answer always the long one? Does your email go to auto shutdown when you’re writing? It’s an email, not a thesis.

If you’re speaking face to face, the clues are a bit more direct, and easy to read once you know how. If your listener is nodding, saying things like “um-hum” or “yeah” that’s a good clue that they’re listening. If they look around the room, over your shoulder, or at their watch, you’ve lost them. Stop. (Maybe they’re captivated by your topic, but they just need to make sure they’re not late to pick up the kids. That’s OK. You should still stop talking. If they want you to continue, you’ll get a very solid clue like, “Go on, what were you saying?”)

When people are interested in your topic, they should be asking questions, or contributing from their point of view. That’s great, it’s a sign that the conversation is flowing well.

Which of course, leads right back to the idea of eye contact. Part of the reason that the speaker periodically looks at the listener is to gauge if they’re still listening. If eye contact is tough for you, you can still look over at the forehead or eyebrows.

Finally, the basic rule is that the closer the relationship, the more intimate the details you share. So it’s probably OK to tell your mom about your latest bout with the flu, but for the office, “I’m feeling much better, thanks!” may be just right.

East Bay Camps for Kids with Special Needs

My upstate New York family may be getting snowed on, but here in the Bay Area, it's spring, with daffodils and cherry blossoms, and that means it's not too early to starting thinking about summer activities for your kids. There are many summer camp programs and a lot of them are geared toward kids and teens with special needs, like autism, Asperger’s, ADHD or other social or emotional issues. Many of these programs fill up quickly, especially those for older campers and the counselor in training programs, and some camps offer a discount for early sign up. Here is a list of just a few, those I’ve heard about that might be worth checking into for your child. Please do your own research since I’m only reporting what others have told me, I’m not professionally or personally involved in any of them. And, if you are aware of other East Bay programs for the summer, please let me know. I’ll edit the post to include anything else I hear of.

Thanks to the members of eastbayautism@yahoogroups.com for your ideas. If you're ever trying to solve a problem and can’t quite come up with the right resource, this group is the place to go. Someone in this group of very helpful people always knows the answers.

Strawberry Canyon Blue Camp's Social Skills camp, on the UC Berkeley campus offers a program for kids with social skills deficits, grades 3 to 12. Younger kids are in groups with a leader, but take part in their activities along with the typical kids from the larger daycamp. For teenagers with special needs, the camp offers a counselor in training program, with focus on social skills as they relate to job skills.

Quest Camps in Alamo offers programs for campers from ages 6 to 18, with special responsibilities and programs for teen campers. They have daily activities, field trips and therapy.

Trails to Success offers their summer camp programs in Orinda. They also have a counselor in training program for teenagers.

Walnut Creek offers a summer therapeutic program through the city parks and recreation. We Care in Concord has also offered an autism summer camp, although I only found online information on the 2009 program. The Easter Seals Kaleidoscope program in Dublin offers an after school program, and I'm told they extend their schedule to longer days over the summer.

Sarah’s Science “This Land Is Your Land” camp is not designed specifically for special needs children, but the science and nature themes may be of interest to many kids. A mom told me that her son with Asperger’s really enjoyed the camp. Older campers can do more challenging projects, and there is a counselor in training program. The camp is located in San Ramon, Berkeley, and Oakland.

Tech Know How offers camps on computers, Legos and game design. Again, this camp is not designed specifically for kids with special needs, but it does match well with the interests of many kids on the spectrum, and a mom reported her child with Asperger's enjoyed it. They have locations throughout the Bay Area.

Using Television to Teach Teens Social Skills

Social skills get more subtle once kids reach high school, and that’s a time when many teens with autism, Asperger’s and ADHD really start to struggle with friends and peer relationships. Often, these kids have gone through the basic social skills training at school or in a social skills group when they were younger. By now, they want nothing more to do with a formal class, but they’re still missing out on some of the more subtle details.

I thought TV episodes might be a useful, fun way to help teens look at social signals. Although the plots of a lot of teen programs are pretty unrealistic, the situations more mature, and the conversations often more adult and introspective than teens really use, the settings are familiar, and the programs are something teens will relate to. They also tend to use body language, but in a bolder, broader way, which can be easier for teens on the spectrum to pick up on. Finally, because these scenes are online, you can watch and rewatch as many times as you want to catch the details, even muting the dialogue to shift focus to the nonverbals.

This week I’m looking at some personal space and nonverbal communication issues as illustrated by the show Glee. You can see these episodes on Hulu.com for free. Note to parents: some of you may object to the more mature themes in this program. I’ll be looking for other shows to comment on as well, but before banning the program, consider if this is something all the other kids at school are watching. Not having seen a popular show can make it hard for kids to fit in. You can watch together, and discuss issues, such as is this scenario realistic, or appropriate, or does this fit with your own values. (If you have a particular show that’s online that you’d like me to analyze, please comment here, or send me an email.)

In Glee, Season 1 Episode 9, Wheels, the show starts with scenes of cheerleading practice. Sitting alone in the bleachers is blonde Quinn, soon to be joined by tall, dark haired Finn. (If you’re new to this show, it might not be obvious from the ways they’re acting that these two are a couple.) Notice the tense body language. As Finn approaches, he doesn’t greet Quinn, he just sits down, at a distance that’s not typical for a dating couple having a one on one conversation. Quinn doesn’t turn to Finn, she doesn’t lean toward him or adjust her body posture, she barely even looks at him. Before anything is said, and without knowing anything about the plot, it’s clear that this pair is not feeling close and connected. Throughout their scene together, Quinn only turns her eyes or occasionally her face to Finn, never her shoulders or the rest of her body, a clear sign of discord between the pair.

Now look at Season 1, Episode 10, Ballad. The show starts with all the students sitting on the bleachers, spaced evenly with almost mathematical precision. (Your teen may not be aware of this spacing rule, but it’s pretty consistent in our culture. People tend to space themselves out fairly evenly, sitting closer to close friends, but not sitting next to strangers unless the space gets more crowded. Think about a movie theater. If it’s almost empty, sitting in adjacent seats is something only friends do. Strangers space themselves out. As the theater fills, it’s not threatening or inappropriate to sit next to strangers.) The exception to the Glee bleacher spacing, which may not be obvious to kids who don’t pick up on social cues, is Quinn and Finn, sitting together as a couple. Finn’s posture isn’t that different than in the previous episode, but now Quinn is leaning into Finn, almost draped on him. Clearly, she is in a different mood than the previous episode. Notice also that the rest of the students are angled slightly toward the center, indicating some cohesion, and friendship alliances can be gauged just by noting who is sitting together. When the teacher asks, “Who knows what a ballad is?” notice how Rachel immediately thrusts up her hand with too much enthusiasm. Can your child glean information about Rachel’s character from this simple action?

Well, I’ve watched about 5 minutes of TV, and written a full post on the details. What details can you and your teen pick up from body language?

Online DIR® Floortime™ Training

I’ve written on several occasions about Stanley Greenspan, M.D. and the DIR® Floortime™ program. I really like this program for several reasons. DIR® Floortime™ can be done by parents, in the home, it doesn’t have to preclude the use of other therapies, such as ABA, and it is very much a social and relational based model, which makes sense to me as a psychotherapist. Of equal value, parents can get started pretty quickly, by reading books, joining an online group, or taking courses, even if they’re waiting for a diagnosis, or in a long line waiting for services. If money is tight, parents can get training relatively inexpensively, and get started without a huge investment. The model helps parents learn to interact with their children in a more engaging manner, taking the child’s developmental level into account and gently helping the child to progress. For parents hoping to enhance their child's social skills, DIR® Floortime™ can be a great place to start.

Stanley Greenspan, M. D. is presenting the Basic Course on the DIR® Floortime™ Model online for parents and professionals, starting on March 12, 2010. I took this online course a few years ago, and really appreciated the ability to take it from home, review the materials as many times as I wanted, and the chance to see Dr. Greenspan in action with children, as well as the relatively low cost. There are also a few workshops being offers, A Lifespan Approach to Autism, Meltdowns, and Regulatory Sensory Processing Disorders.

Treatment Options: What is P.L.A.Y. Project®?

There are so many treatment options for children on the autism spectrum, it can be really confusing for parents.  Different programs may sound like the same thing, other programs have trademarks, or they’re proprietary, or they’ve been developed in one location and not available elsewhere. What’s the difference? Is there one best treatment? Can different  programs be used together? In the end, it all comes down to one question: how do you figure out the best treatment for your own child?

In the interest of sorting this out, I try to provide specific information when I can find an expert who is really knowledgeable about a specific treatment program. For example, you can see an earlier interview on DIR/Floortime.

One option that you may have heard of is P.L.A.Y. Project®. Today I’m taking to Joanne Finn, a Licensed Educational Psychologist, who also provides private services as a home consultant for families of children with an autism spectrum disorder through the P.L.A.Y Project®.

Patricia Robinson:
Joanne, Can you explain the P.L.A.Y. Project®?

Joanne Finn:
P.L.A.Y Project® was started by Dr. Rick Solomon, a developmental pediatrician, who wanted to develop an affordable, family-friendly and effective early intervention program for children with autism spectrum disorders ages 18 months to seven years.  P.L.A.Y Project is an international program with home consultants serving families in 27 states and 3 countries outside of the U.S.  The program focuses on helping parents to help their children build emotional connections and engage in meaningful relationships.

As a school psychologist, I became interested in finding more ways to support parents who really wanted to help their children at home. A friend introduced me to  DIR®/Floortime™ and I was excited to find the P.L.A.Y. Project model of home consultation. I recently became a licensed provider for P.L.A.Y. and I am so happy to be able to provide this to parents.  What I really love about being a PLAY home consultant is working with parents. Children spend more time with their parents than all of their teachers and therapists combined. So parents are really the best ones to help their child learn to connect.

P.L.A.Y Project uses the DIR®/Floortime™ model of Dr. Stanley Greenspan, a nationally respected child psychiatrist. DIR stands for developmental, individual-differences, and relationship-based. This means that parent-and-child interactions are highly valued and respected.  A child’s emotional development depends so much on the intimate connection between a baby and parents – from early smiles and coos, to looks and gestures, verbal language, and ideas about how the world works.  For a child with autism these connections can be disrupted because of the child’s challenging neurological disorder. As a home consultant I carefully analyze a child’s unique individual differences to determine the best play activities, methods and techniques to help relationship happen. And it does happen!  Dr. Solomon’s initial pilot study of 70 children with autism demonstrated that 65% of the children in the P.L.A.Y. Project made good to excellent progress.  P.L.A.Y. Project has recently been awarded a $1.85 million grant from the National Institutes of Mental Health to conduct a three-year study of the model. 

P.L.A.Y. Project is one type of  DIR/Floortime service delivery model.   Floortime therapy can be delivered many different ways - through a school program like Creekside, during OT or Speech therapy, through private play therapy by a psychologist, through clinic or home consultation.  P.L.A.Y. Project consists of a specific structure to provide DIR/Floortime through home consultation.  Aspects specific to P.L.A.Y.include use of the PLAY Project Workshop DVD for an initial introduction, a 3-hour home visit once or twice monthly, the use of video and video feedback reports as part of the coaching.  PLAY project home consultants must be trained in DIR/Floortime techniques by PLAY Project trainers and must work with a licensed PLAY Project agency. (I am my own licensed agency). Home consultants are also strongly encouraged to participate in ICDL DIR/Floortime Institute certificate program.

P.L.A.Y Project format looks like this: As a home consultant, I make one or two home visits per month for a 3 hour block of time. During that time I observe parent and child during play sessions and during their daily routine. I offer coaching and support to the parents, and as the child builds trust I model play techniques for the parents.  With permission, I also videotape some of the play.  Between visits I analyze the videotape to better understand the child’s strengths and needs.  And I provide additional input in the form of a Video Review report.  The parent receives the report and the video between visits to help them continue their learning and to help train others such as grandparents, friends and other caregivers.

Most of my current families are using P.L.A.Y Project to supplement their child’s half-day school program or ABA home therapy.  P.L.A.Y. Project and ABA are complementary and have different strategic directions.  DIR/Floortime is distinctive from ABA as it emphasizes following a child’s interests and preferences rather than therapist initiated activities.  DIR/Floortime emphasizes emotion to create engagement and connection rather than primarily focusing on building skills. And PLAY Project’s main focus is integrating parents into the therapy.

Patricia Robinson:
Joanne, thanks for explaining the details of this program. East Bay parents in Northern California can contact Joanne Finn  directly through her website, and those in other locations can check out the P.L.A.Y Project website to find a local provider.

Playing Outside

Playing outside is one of the core experiences we all remember from childhood, but all too often it doesn’t happen for kids with special needs like Asperger’s, autism and ADHD. And that’s really a shame, because outdoor play is often the easiest way for all sorts of diverse personalities, abilities, and ages to interact.

School politics can get very specific, with each child interacting with only the chosen few in a social clique. Different ages, groups and genders rarely mix at school. But kids aren’t quite so particular when it comes to neighborhood play. A lot of that just comes from opportunity. In neighborhood play, there just aren’t so many kids to choose from. It’s not uncommon for neighbors who’d never talk at school to spend days together at home, having a great time. There’s nothing wrong with this. Schools can be about cliques, but home can be much more open. Not every neighborhood friend has to turn into a best friend at school.

The great thing about outdoor play is that it’s unstructured. There aren’t rules like there might be in team sports, there aren’t even goals or objectives. Kids can just run around, invent new games and be creative. And that’s where kids with ADHD and ASDs can really shine. Their creativity and energy may make these kids the highly sought after playmates.

Why don’t you give it a try? Make sure your children are spending some time in the front yard where the neighbors can find them. Pay attention to where other kids live. Then, maybe your child can take the plunge. Parents have to step back here, but it’s easy to coach your child. Just ring the doorbell, ask for the child and say something really basic like, “Hi, I’m Matthew. Do you want to come out and play?” That’s it. That may be all it take for your child to interact with peers, spend time outside, and probably have a great time.

Are You Off to a Good Start with the School Year?

Here in the East Bay, most schools are in the second week of the new school year. It’s a stressful time, because everyone is dealing with a lot of change. This time of year can be especially difficult for kids with ASD’s like Asperger's or autism, or attention issues like ADHD or ADD. Routines are not yet established, teacher expectations are uncertain, and social issues are constantly changing. With all this going on, it really pays off to check in closely with your kids.

I worked with kids for years, both as a therapist and in the schools, and from this I know that the most proactive parents get the best results. It’s a hectic time of year, but a little extra effort now will pay off. In my experience, teachers and principals really are trying. But, budgets are tight, there may be misunderstandings, there are too many kids and not enough time. No one is as motivated to help your child as you are. Here are a few early check-in points.

1. Does Your Child Get the New Systems?

Homework, bringing home books, using the library, getting extra help, lunchtime routines. Every year the rules change a bit. It can be very confusing for any child. But, now is the time to make things clear. Maybe you can run through your child’s day and make sure there’s no confusion.

2. Are Friendships Starting Up?

I can’t stress enough that the beginning of the school year is when most kids shift friendships. It happens gradually, but the groundwork is being laid now. Help your child maneuver through these confusing changes. Just talking about it can help make things clear. Teachers can be a great resource when there are problems.

3. Monitor the Situation

Are there potential issues showing up early? Maybe you won’t want to do anything, but just pay attention to it. Or, if the problem is severe, catching it early can allow you to make a quick fix, like a classroom transfer that won’t be possible in a few months.

Of course, you shouldn’t be combative with the school, after all they are responsible for your child for hours every day. But that doesn’t mean you can’t track things carefully. Jot down private notes if you’re uneasy about a school situation. If things get worse, you’ve got some data, and if the problem goes away, no harm done. Too often, I see parents frustrated by months of difficulties, and only then do they start to document the details. An entire school year can be lost when that happens.

Pretty soon, things will settle into a routine and it's going to be a lot easier!

A Survival Guide for the First Day of School

Back to school is a stressful time, but it can be especially difficult for kids with ASDs and ADHD. But, now is the time to take a few steps to ensure more success this school year. The beginning of the year is the time to get organized, and to make new friends. Keep these tips in mind before going back to school.

1) The Unknown Can be Scary

Try to familiarize anxious kids with the school environment before the first day. Take a tour, figure out where the classrooms are, stop in to the office or walk by the homeroom.  Some schools might even allow you to meet the teacher. Other schools publish a class list or have an orientation picnic.

2) Take Your Kids to School On the First Day

Most school are packed with parents dropping kids off on the first day. This is your perfect opportunity to meet other parents. Remember, lots of parents are uncomfortable with playdates if they don’t know the other parents. You want to start meeting moms and dads now.

Also, the teachers are looking for volunteers right now. Here’s a perfect opportunity for you to get involved at school and know the parents and teachers better.

3) PTA Events

Many schools have a PTA coffee on the first morning, another chance to get to know people. (Remember, the principal or office staff will probably be there. You want them to know you’re willing to help out and give back.)

4) Be Sure To Go To Back To School Night

Back to School Night is your first opportunity to find out what the teachers expect, how their classroom are organized and to show that you’re a concerned parent. You may not have a chance to hear from your child’s teacher until after the first report cards, so this is an important opportunity.

5) Discuss Lunchtime Plans with your Child

Lunchtime and the daunting cafeteria full of kids at long tables can be the scariest part of the day.  I always suggest kids try to walk into the cafeteria with a friendly classmate if possible. Don’t dawdle or rush there! You child needs to be a part of the crowd now. Some kids bring a small lunch as well as some money so they can either go directly to the table or get in the cafeteria line, depending what their friends are doing.

6) Figure Out How to Communicate with the School

Every school is different. Some have a computerized communication system, others want everything on voice mail or through emails. Set up the system now, so it’s ready when you need it.

7) Plan for PE.

Getting into PE clothes at school can be a stressful experience for shy kids. Find out the requirements at your child’s school and come up with a plan to make your child as comfortable as possible. The teachers may have some tips here, but be discrete. Don’t embarrass your child by discussing this publicly.

8) Back to School Clothes

Clothing makes a statement, and every school has it’s own style. Many kids don’t care what they wear, others want to be dramatic or different. That’s fine, unless your kids have struggled socially. If your child wants to make more friends, it makes sense to dress to fit in. (Don’t do all the back to school shopping early. Get a first day outfit, see what kids are wearing and then shop.) Popular kids set the trends, but less powerful kids may be ostracized merely because they dress too immaturely or oddly.

9) Give some Leeway at Pickup Time

After school is the perfect time for your child to chat with new classmates, or even plan an outing. Try to be there after school, so your child doesn’t have to wait, but set it up that you can wait a few minutes if they want to talk to new friends.