Autism and Co-occurring Disorders with Susan W. White & Carla Mazefsky

Dr. Carla Mazefsky is an Associate Professor of Psychiatry at the University of Pittsburgh School of Medicine, where she is Co-Director of the Center for Autism Research (CeFAR) and the Director of the Regulation of Emotion in ASD Adults, Children, & Teens (REAACT) Research Program. She is a past recipient of the INSAR Ritvo-Slifka Award for Innovation in Autism Research. Her current studies take a lifespan approach, with an emphasis on adolescence and the transition to adulthood.  Her research focuses primarily on emotion regulation and associated mental health and behavioral concerns in autism spectrum disorder (ASD), including the mechanisms underlying emotion dysregulation in ASD and the development of new assessment and treatment approaches. She is co-editor of the Oxford Handbook of Autism and Co-Occurring Psychiatric Conditions, author of the Emotion Dysregulation Inventory, and co-author of the Emotion Awareness and Skills Enhancement (EASE) Program.   

Susan W. White is Professor and Doddridge Saxon Chair in Clinical Psychology at the University of Alabama. Her clinical and research interests include development and evaluation of psychosocial treatments that target transdiagnostic processes underlying psychopathology. She is associate editor for the Journal of Clinical Child and Adolescent Psychology and the Journal of Autism and Developmental Disorders, and she the Editor in Chief of the ABCT Series on Implementation of Clinical Approaches. Her research has been funded by the National Institutes of Health and the Department of Defense. She received her PhD from Florida State University.

All Autism Talk (allautismtalk.com) is sponsored by LEARN Behavioral (learnbehavioral.com).

Early Detection and Treatment for Autism with Dr. Geraldine Dawson

Geraldine Dawson is the William Cleland Distinguished Professor of Psychiatry and Behavioral Sciences at Duke University, where she also is Professor of Pediatrics and Psychology & Neuroscience. Dawson is the Director of the Duke Institute for Brain Sciences whose mission is to promote interdisciplinary brain science and translate discoveries into solutions for health and society.  Dawson also is Director of the Duke Center for Autism and Brain Development, an NIH Autism Center of Excellence, which is an interdisciplinary research program and clinic, aimed to improve the lives of those with autism through research, education, clinical services, and policy. She has published several books on autism, including An Early Start for Your Child with Autism, A Parent’s Guide to High-Functioning Autism, and  What Science Tells Us about Autism Spectrum Disorder.  Dawson’s pioneering studies were among the first to describe the emergence of autism symptoms during infancy, leading to new screening tools. Dawson co-created the Early Start Denver Model, an early autism intervention shown to improve behavioral outcomes, which has been translated into 17 languages and is used worldwide. Her work showed for the first time that early intervention can normalize aspects of brain activity in children with autism, changing the field’s view of brain plasticity in autism, a finding recognized by TIME Magazine as one of the top 10 medical breakthroughs of 2012. A strong advocate for persons with autism, Dawson has testified a number of times before the US Congress in support of major autism legislation and was appointed by the U.S. Secretary for Health and Human Services for two terms to the DHHS IACC.

All Autism Talk (allautismtalk.com) is sponsored by LEARN Behavioral (learnbehavioral.com).

Spotlight on Diversity in ABA: An Interview with Joshua Polanco

A board certified behavior analyst (BCBA), managing technician, at LEARN’s Autism Spectrum Therapies (AST) in California’s Inland Empire region, Joshua Polanco provides supervision and behavioral intervention plans for clients in need of ABA services. He earned a master’s degree in psychology and ventured into ABA because he wanted to use that degree in a more direct and meaningful way. He’s also legally blind.

Here, he shares stories from his journey and experience working with children and young adults with autism—and his take on the importance of diversity, equity, and inclusion (DEI) in the field of applied behavior analysis (ABA).

 

Q: WHY DID YOU GET INTO ABA?

A: I was working as a behavioral technician and providing one-to-one services with multiple clients. I was about to quit after the first two weeks of working in the ABA setting because I did not have any experience with children with disabilities and felt like I was not helping my clients. Ironically, the clients and their families are what made me stay. To me, nothing can beat the sensation of knowing you have made a difference in someone’s life, and I have had so many fun experiences that helped me realize the importance of ABA, and how prevalent it is in our everyday lives. All of these experiences are what drove me to continue pursuing ABA to the position where I am now.

 

Q: WHAT DOES DIVERSITY, EQUITY, AND INCLUSION (DEI) MEAN TO YOU?

A: Everything. I feel these concepts as a whole are very overlooked at times. It’s not only important to have diversity, equity, and inclusion in the workplace but to also recognize the benefits provided when DEI is incorporated into a work environment. In my case, I may be legally blind, but that does not make me useless in a work environment that relies heavily on vision. I am able to continue to make an impact on peoples’ lives through my work and can actually provide a different perspective and understanding when helping clients or co-workers because of my loss of vision.

Q: IN YOUR OPINION, WHAT IS THE MOST CHALLENGING ASPECT OF WORKING IN A DIVERSE ENVIRONMENT?

A: Trying to comprehend various interactions that take place. Balancing the state of empathy and understanding, while simultaneously needing to support and accomplish work objectives that need to be achieved.

Q: WHAT IS YOUR APPROACH TO UNDERSTANDING THE PERSPECTIVES OF COLLEAGUES OR CLIENTS FROM DIFFERENT BACKGROUNDS?

A: The short, easy answer is that I take a step back and just listen. Self-awareness and self-control over your own biases and habits go a long way. It’s important to me to recognize the limitations you have in the moment. For example, you may not always be able to truly understand the perspective of others. This is OK—we are only human. I feel like there are ways to still attempt to understand to some degree. Failure to truly understand someone should not give us permission to disregard their perspective.

I’ve relied, to some degree, on multiple psychology books, articles, and notes from when I obtained my master’s degree in psychology, with an emphasis in clinical counseling and marriage and family therapy. When communicating with colleagues and clients, I always try to review and remember the concepts I learned on the dynamics of communication, including those on cognitive distortions and positive feedback loops. Understanding these can play a huge role on how I understand and communicate during a conversation.

Q: WHY IS DEI IMPORTANT IN ABA?

A: Without DEI, we would be refusing to grow ABA as a whole. ABA is a science that expands to more than any one individual population. Part of everything we do is to help, expand, and make a difference in the world. What better way to accomplish this than to recognize the different things people have to contribute.

Q: TELL ME ABOUT A TIME WHEN YOU ADVOCATED FOR DIVERSITY AND INCLUSION IN THE WORKPLACE OR IN YOUR PERSONAL LIFE.

A: One poignant instance in which I had to advocate for myself is the moment I was officially diagnosed blind, and I had to reach out to the HR department to figure out some resolutions and next steps forward. Luckily, I was part of a supportive team and was able to continue doing the core work I was educated to do and hired for, with some slight accommodations and adjustments.

Q: WHAT’S SOMETHING MOST COLLEAGUES DON’T KNOW ABOUT YOU?

A: I do not know how many people know that I am legally blind. My condition is called Retinitis Pigmentosa (RP). There is no treatment. With this condition, my vision will gradually worsen. There is no telling how much vision I will lose tomorrow…or over the next 30 years. I don’t only have to think about how this affects the work I do with clients but how I adjust my everyday life to prepare for this. Through my work with rehabilitation specialists, I am learning to use technology, to read braille, and even to cook without looking.

Q: ANYTHING ELSE YOU’D LIKE TO ADD?

A: I was diagnosed legally blind less than a year ago. In that time, I’ve taken and passed the BCBA exam, which was the first test I’ve ever had to study for and take without my vision, while finding ways to balance my work, as I learn a new lifestyle. I hope the message from all of this is one of inspiration—that no matter how bad things may seem, it’s important not to let the events around you, define you. Take control of the things you can, adapt, and persevere through the adversity. Because this is what we ask of our clients each day.

For more from our Spotlight on Diversity in ABA series, read “An Interview with Angela Parker.”

Neurodiversity: What It Means, Why It Matters

BY RONIT MOLKO, PH.D., BCBA-D
STRATEGIC ADVISOR, LEARN BEHAVIORAL

If there is one enduring hallmark of the American experience, it’s the immense diversity found within our expansive borders. Most of the time, we perceive diversity via differences in skin color, language, clothing, places of worship, or even the foods people eat when gathered around the table with their families. There is, however, one major aspect of diversity that is often overlooked—one that comes as no surprise, considering it cannot be detected solely through visual means. I am, of course, referring to neurodiversity.

Coined in the late 1990s by sociologist Judy Singer—who is on the autism spectrum—neurodiversity is a viewpoint that characterizes brain differences among individuals as normal, rather than as a disability. This viewpoint reduces stigmas around learning and thinking differences, while calling attention to the ability of neurodivergent communities to benefit from multiple perspectives and make greater contributions to society. Central to the movement is a rejection of the idea that these unique individuals need to be cured or fixed. Instead, it’s held that people possessing different types of brains need to be embraced and provided support systems that allow them to participate and contribute as members of the community to the best of their ability.

Grounded in Science

Unsurprisingly, the foundations of this not so new movement are grounded firmly in science and empirical study. By leveraging MRI results from hundreds of individuals, researchers have been able to compare the brains of people diagnosed with learning differences to their counterparts. So far, studies have shown that the brains of neurodivergent individuals are, in fact, unique. For example, the part of the brain that maintains language processing works differently for people diagnosed with dyslexia. Additionally, the prefrontal cortex, which manages executive functioning and attention, develops much slower in children diagnosed with ADHD. In other words, these individuals are not necessarily operating with a learning deficit but rather possess brains that are literally wired differently.

A Neurodiverse Population

Whether a group of kids recently diagnosed with autism or adults still grappling with ADHD or dyslexia, the American neurodiverse population is quite substantial. According to a 2021 report from the Center for Disease Control and Prevention, one in every 44 children in the United States is diagnosed with some sort of autism spectrum disorder, and an estimated 5.4 million adults—or roughly 2.2 percent of the entire population—fall somewhere along the spectrum. Many people on the spectrum have contributed (or still do) to their communities every day, such as Albert Einstein, Anthony Hopkins, Henry Cavendish, Greta Thunberg, Jerry Seinfeld, and Elon Musk. They have been among the world’s highest achievers, impacting the arts, sciences, technological innovation, and activism.

In much the same way as the neurotypical population, the neurodivergent population is broad, diverse, and multidimensional. It’s crucial, then, for the public not only to embrace their different brethren but also to actively promote opportunities for them both in society and in the workplace at all abilities and levels.

Fortunately for society writ-large, corporate America is starting to take notice. A recent article published in the Harvard Business Review named neurodiversity as a bona fide “competitive advantage,” noting the unique and, often, incomparable output provided by atypical members of their workforce. Numerous companies, including Hewlett-Packard, Enterprise, Microsoft, SAP, and Ford, have recently begun to reform their HR practices in an effort to expand neurodiversity in their ranks by identifying, hiring, and empowering these unique individuals. The results, so far, have been outstanding, with managers noting legitimate “productivity gains, quality improvements, boosts in innovative capabilities, and broad increases in employee engagement.”

Diversity of all kinds, including neurodiversity, strengthens our daily institutions. Just as we are seeing a focus on diversity, equity, and inclusion (DEI) in employment and other areas of life and commerce, we must also remember that recognizing and celebrating differences, promoting justice and fairness, and ensuring true support and inclusion applies not only to people with observable differences but also to our neurodiverse populations. Not all cognitive differences are visible, and it’s crucial to keep in mind that there’s more than meets the eye when it comes to true diversity.

In another blog post, Dr. Molko explains the history and evolution of applied behavior analysis (ABA) therapy. Read the story.

How can Parents Embed Language?

Many people think of speech-language pathologists (Speech Therapists or SLPs)as professionals that work with people to improve their speech (also called articulation or fluency), but a big piece of SLPs job is to help children with language development. Language is so important for individuals to function in school and life. When children have a developmental delay that impedes their ability to effectively communicate, SLPs work with parents, teachers and other caregivers to develop strategies that improve language acquisition.

Children learn language and communication from their environment and from their experiences and interactions with the people in their environment. Studies have shown that on average, about 90% of the words used by children by the age of three come from their parents’ vocabularies. Children imitate the number of words spoken, the length of conversations and the speech patterns of their caregivers.

This is why it is so important for parents and caregivers to actively engage their infants and children by talking to them as much as possible. The number of words a child hears per day will greatly impact their vocabulary and their language development, and ultimately this impacts success in many other areas for children as they develop. It does not need to be complicated- simply noticing your environment and commenting on it to your child is all it takes to stimulate your child’s learning of language and communication. It’s the frequency that matters.

One of the easiest ways to encourage the learning of language and communication is by encouraging talking during your normal, daily routines. Activities such as bathing, dressing, mealtimes, cooking, doing laundry, going for a walk, driving in the car, and grocery store shopping are all typical daily routines and activities during which you can embed all kinds of important skills that we want kids to learn (see reverse for 10specific ideas).

Below are ten specific skills related to language development with examples of how to insert those into daily activities:
1. Joint Attention Skills:

When looking at pictures, reading books, or even just playing with children, it is important that the child looks at the object, picture, or toy that you are talking about. This ensures that the child is listening and is able to understand the object or picture being labeled and described.

2. Turn-Taking:

Teaching children to respond to physical and verbal directions sets the stage for understanding how to share between two people. For example, when playing with a toy car, if the parent pushes the car to the child and says “vroom-vroom”, the parent waits for the child to respond by pushing the toy car back to them and imitating the sound.

3. Language Stimulation:

During all kinds of daily activities, talk to your child about what you are doing, seeing, hearing, etc. in your environment.

4. Play Skills:

Through play, children often show us what they understand about the world. This is how children discover and learn about objects, people and the world around them. Play with your child often and talk as you play about what you are doing.

5. Fill in the blank:

Set up a predictable, language routines, for example, set up a familiar phrase and purposefully leave out the last word, i.e., While singing “the wheels on the bus go round and ____, round and _____.” Or while reading “brown bear, brown ____.” Gradually make the task more complicated, i.e., during a favorite book, you can exclaim, “Oh, no…look…Clifford is laughing…he feels ____.” Prompt your child by looking at them and waiting for them to reply. Once you do this a few times, they will catch on.

6. Provide choices:

Provide choices instead of asking questions so your child does not have the option of answering “no” when you want to stimulate interaction. Instead of asking your child “Do you want to play with your cars” ask “Do you want to play with your cars or train?”

7. Picture walk: 

It is not necessary to read every word in a book as they can often be too wordy and confusing for the early learner. Instead, encourage your child to look at the pages and guess what is going on. Set up a familiar structure to help your child express herself—go through the book and point out familiar nouns/verbs using the phrase, “I see___”… “I see a puppy.” “I see a sun” while pointing to the object. Next, take your child’s finger and put it on an object you are sure he/she is familiar with and use the fill in the blank procedure “I see a _____ (CAT!)”.When your child becomes familiar with the routine, he/she will begin to say the phrase by herself. This sets up the routine of “my turn-your turn”.

8. Out of reach:

Put desired objects in out of reach places to encourage your child to request and ask for help. A natural instinct for parents is to make everything easier for their child—but many times we are actually doing a disservice when we anticipate our child’s every need. Once a child realizes the power of language, they will talk for what they want.

9. Confusion:

This can get your child talking and it is a nice time to introduce early language concepts in a very concrete way. So—the next time you are at the table and your child asks for peanut butter—give him regular butter instead. Wait for him to tell you that this isn’t what he asked for—at that point you can say “But, Didn’t you ask for butter?”—“NO! PEANUT butter mommy!”—“Oh, I get it now. Peanutbutter and butter are the same in a lot of ways—we can spread both of them on bread, they are both soft and they both have the word “butter” in them! But, they are also very different…peanut butter is a darker color—more like a light brown—and it is sweeter.”

10. Ask and then, Listen:

Once your toddler is talking, start teaching them to initiate conversations, and listen, a lot. You will be surprised once you stop talking about how much more your toddler will talk. This will give your child an opportunity to practice initiating communication and then you can let your child take the lead. Initiating conversation lays the groundwork for many social skills that are so important for future development.

-by Amy Hill, M.A., CCC-SLP and Ronit Molko, Ph.D., BCBA-D

Our amazing daughter

Autism is a diagnosis that can be emotional for parents and families to accept. In our case, the diagnosis needed to be accepted by our family. Our daughter is amazing. She is incredibly bright, sweet, and an absolute joy to be around. As a parent, one of the most gut-wrenching things we experienced was being told time after time, “Your child has challenges, but no one knows why.” In May of 2013, we finally got our answer. Our beautiful girl has a rare genetic condition called Cohen Syndrome that causes intellectual, medical, and physical disabilities. Receiving this diagnosis was bittersweet because we finally got an answer, but we still didn’t know how to help our daughter. With a rare genetic condition like this, there are several programs, specialists, and therapies available that we didn’t even know existed. There are people with resources who wanted to help but had never heard of our child’s condition. It was very alarming for us because even though we were thankful for their help, the process can be anxiety-inducing.

When our daughter was diagnosed with Autism a year ago, it wasn’t a bittersweet moment like when we received her original diagnosis of Cohen Syndrome. It was just sweet! Autism Awareness has been raised, and there are people in the education and medical field who have experience with Autism. I fully accept that our daughter has Autism, but the fact is that a lot of her challenges stem from her primary diagnosis that is rare. I asked myself how this “known” diagnosis could help when you have to take her “unknown” diagnosis into account? The answer was ABA therapy.

Although we have seen AMAZING progress through ABA therapy in our daughter over the last year, the truth is that it cannot be contributed fully to “just” ABA therapy. ABA therapy with the right team is the answer. What makes the right team? Compassion, humility, resource-connected, knowledgeable, and experienced team members. ABA is an evidence-based practice.

We know firsthand that having a team that is compassionate and humble will allow for success. Having a child with complex healthcare needs is overwhelming. We almost always feel like we aren’t doing enough (are we acting more like advocates instead of just being mom and dad? Is our child receiving the right therapies, too many or not enough? How can we balance comfortability for a child whose world is almost always uncomfortable, but also push her to reach her full potential?). Adding ABA therapy to our already crammed schedule brought apprehension. But having the right team, takes the stress out of the equation. We (parents, child and staff) work together on proper goals and time management.

ABA is an excellent tool that I highly recommend families consider, but it’s not the only tool. Especially when working with a child who has a rare genetic condition plus an Autism diagnosis. Other resources and tools may assist families in achieving their goals. For us this meant learning about the objectives as a family together while our daughter was mastering goals. ABA works best when it’s combined with your other resources; (i.e., current therapies in place, IEP teams, community support, etc.) as this helps generalize what is learned. We have seen our daughter transfer the skills she’s learned in her sessions into her everyday life. Our daughter, recently turned eight years old, received a skilled companion dog, and is transitioning to a general education classroom. This transition and the skills that her amazing ABA team teach her have been a blessing to her, and our family. Our daughter has been showing more affection to those she cares about. She’s able to master her goals outside of her sessions and into the community (which I am unable to express how HUGE this is). She is also able to complete her homework with modifications; additionally, she can share who she is with others instead of allowing her diagnoses to define her as others think it does.

From a logical perspective, ABA therapy is remarkable in how it allows children (no matter what the diagnosis is) to learn things that other children may more readily know. From a mom’s perspective, it’s beyond amazing. This process has provided my husband and me with the support needed so we can be her parents, instead of her providers. Partnering in this way gives us opportunities we wouldn’t be able to have without this kind of assistance. There’s a saying that it takes a village to raise a child. In the early days of our daughter’s life, my husband and I would jokingly say it takes a hospital to raise our child. As her health has become more stable, and we’ve been able to focus more on her education and life skills, we agree that in fact, it takes a village to raise a child — a properly equipped village. And we are so grateful that God blessed us with her ABA team as an addition to our village.

– by Nicole

The Benefits of ABA in Dual Environments

When a child is diagnosed with autism, parents become charged with finding quality treatment – and the evidence-based recommendation is to seek out Applied Behavior Analysis (ABA).  Choosing the specific ABA program that is right for a child can feel daunting, especially if ABA is new territory for a family.  In this article, we look at the benefits of a program incorporating both in-home and center-based programs.

Many proponents of ABA like to state, “ABA can be done anywhere.” It is true – but we shouldn’t overlook another important point: the environment itself is a critical component of therapy.  Controlling the environment to some degree is frequently part of the teaching process.  Selecting a teaching environment is a decision that impacts the rest of the teaching strategy and so also has an effect on progress.

Common teaching environments for young children with autism include center-based ABA therapy, private or public school, a childcare environment, and home programs.   While there is not enough research to prescribe a particular environment or model generally for children with autism, many parents and professionals are finding that a multi-site model of a controlled environment (such as a center-based program) and a natural environment (home, childcare, school) provides the best of both worlds.

Benefit #1 – Social skills can be targeted consistently and with children in the child’s community.

It is necessary for peers to be available regularly for consistent teaching; in this respect, a clinic setting is ideal for having regular access to other children to practice target skills.  Ultimately, the goal is for the child to interact with the other children in their community, their siblings, classmates, and neighbors.  Having a regular home component allows the therapist to work on target skills with the people who will be important in their normal daily life, even if these opportunities aren’t as regular as those in a clinic setting.

Benefit #2 – Controlled Environment vs. Natural Environment: Best of both worlds

A multi-site model allows technicians to address the most challenging skills in a distraction-free environment, but still have access to the home or school setting, with all of its naturally-occurring distractions, to make sure that those learned skills are being put to use.

Benefit #3 – Consistency of the Behavior Plan

When a challenging behavior is treated differently across settings, it is more likely to persist; this set-up can even make the behavior worse in the long-run.  The best treatment involves the same plan being followed across the day.  Having professionals use a consistent plan in both the home and center environments also supports family members to do the same.

Benefit #4 – Assessment of Generalization

All programs must address the issue of generalization, but a multi-site model is tailor-made for this.  Generalization can be specifically addressed right from the beginning, either by teaching in both environments, or by teaching in one place and testing generalization in the other.

Benefit #5 – Ease of Group Work Vs. Ease of Parent Training – You Get Both!

One of the most important aspects of the teaching environment is the people present.  In a center-based program, other children are close at hand for social interactions, peer modeling, and working on group instruction, so these parts of therapy can happen regularly.  When ABA sessions are at home, it can be more convenient for parents to make themselves available for training.  In a multi-site model, the child benefits from both of these types of teaching opportunities.

Whichever provider a family selects, they should be sure to work closely with their team to personalize the child’s program to best meet their needs and the goals for their family.

– Richie Ploesch, M.A., BCBA & Katherine Johnson, BCBA

Preparing for Holiday Meals

The holidays are quickly approaching, which means family, festivities, and food! While the holidays can be fun for the whole family, they can also be a stressful time for children on the autism spectrum due to the changes in typical routines and settings. Holiday meals with extended family can present issues for a child with autism, including trying new foods, sitting among loud family members, and being in an unfamiliar location. Here are some helpful tips to make the holiday experience more enjoyable for the whole family.

Prepare your child for the event.
Use photos, a social story, or show them a video, modeling what will be expected of them. Will they need to sit at a communal table surrounded by family? Will they be expected to try new foods? How about preparing your child for the family members who will be present? You can practice with role play at home with real or fake food so your child is familiar with the expectation of the meal. To make it easier this time of year, you can also bring some favorite foods along that you know will be successful.

Support them during the event.
Bring activities and toys so your child has something to do while waiting for the meal to begin. If your child is very picky with food, bring some preferred alternatives that they will eat so they don’t become agitated while waiting and to remind your child of familiar food routines.

Give them a chance to escape if they need it.
If your child becomes overstimulated by loud noises or holiday lights and decorations, find a quiet place in the home for them to decompress and take a break. Your child can rejoin the family once he or she feels comfortable doing so.

While holiday meals can be stressful, hopefully these tips will help keep everyone’s spirits bright!

 

– Sarah Low, M.A., BCBA

How to Plan for the Upcoming School Breaks

In Tucson, Arizona many of our kids are heading into their Fall Break.  Your child’s breaks may come at different seasons and times of year. School breaks offer opportunities and challenges for all parents and children. These breaks can cause disruption in family routines and increase in down time for the child, which may result in low levels of motivation and higher levels of anxiety and stress. For parents of children with special needs, these may seem magnified. Below are some helpful tips to consider when planning for your child’s upcoming school breaks.

 

Keep Similar Routines
This may be easier said then done however, keeping your wake-up and bed-times similar and filling the day hours with activities will provide your child a predictable, structured environment, a sense of stability, and decreased stress. By reducing the amount of unstructured free time, your child will be less restless and bored. Don’t forget to include the homework routine as you have worked so hard to develop and maintain this prior to the break!  It is still important for children to practice academic skills even though school in not in session.

Keep Busy
Find educational, recreational and social activities to engage in daily. This will limit the amount of time your child is at home watching TV, texting, or playing video games. Ideally, an outside activity such as playing ball, going for a walk or participating in a team sport would be on the schedule daily. Even if your child doesn’t play a sport, any exercise activity has obvious health benefits, and increased physical activity helps reduce repetitive behaviors and improve sleep. Some resources to find community activities are your local Parks and Recreation Department, newspaper, and libraries. Some examples of home activities are board games, arts and crafts, academic tasks, meal preparation, outside games and reading.

Have a Daily Visual Schedule
The whole idea of a school break may be confusing for younger children since they are still developing the concept of time. School breaks also challenge the typical Monday-through-Friday predictable morning, school and after school routines. Utilizing a visual schedule will help your child understand the “what, when, where and why” of their day. It is also important to involve them by letting them choose what activities they would like to do. You can also have them cross off completed activities as well as the days so they can see how many days are left until school starts.

Read to your child
Children are exposed to literacy concepts many times throughout their school day. Continuing to expose them to books while they are home will only increase their language development, listening, and comprehension skills. Reading to your child also stimulates their imagination and facilitates a positive interaction where they receive one-on-one attention from the parent. Research recommends that parents set a side a scheduled time each day to read to their child (Raisingreaders.net).

Limit electronics
Allowing a child unlimited access to TV and computer can lead to childhood obesity, lethargy, difficulty in school, and insomnia. The American Academy of Pediatrics recommends children be limited to 1 to 2 two hours of educational programming daily. Here are some ways to limit your child’s access to electronics: First, keep them out of reach and out of your child’s bedroom. Have your child earn their time with electronics upon completion of other activities. Specifically allocate times within the day that are appropriate for your child to have access to electronics.

Work on Social Skills
This is the biggest opportunity provided by school breaks. Integrating social opportunities within your child’s day can take many forms such as homework assignments, board games, community activities, sports, and play dates. Some parents forget that activities like swim lessons, apple picking, and vacation trips can all be valuable new settings to prompt the use of social skills.

 

Hey Tucson families! Here are some additional resources to help make your season great for the whole family:

 

– Lindsay Abbott, MA, BCBA, LBA

Beyond Picky Eating – Addressing Your Child’s Feeding Issues

Feeding is part of our daily life. Most people eat at least three times per day and mealtime is typically a pleasant experience; however, for children with feeding problems, this daily routine can become an aversive situation for children and their caregivers. 

Studies suggest the majority of children with autism have some type of a feeding problem (Volkert & Vaz, 2010). Feeding problems can include complete food refusal, disruptive mealtime behaviors, inappropriate pace of eating, lack of self-feeding skills, and “picky eating,” as caregivers often refer to it.

“Picky eating” may consist of a variety of selective feeding behaviors such as only eating foods of certain textures (e.g., crunchy, pureed), brands (e.g., from a particular restaurant), types (e.g., meat, starches), or colors.  When a child does not eat enough or does not eat a wide enough variety of foods, there may be significant medical implications (e.g., weight loss, malnutrition, poor growth) or social implications (e.g., not eating with peers, at family gatherings, or at restaurants). Children with feeding problems can create additional burdens on caregivers if caregivers need to prepare a separate meal for one family member, bring special food on community outings, or decline attending social events in fear of how their child may behave when presented with novel foods.

Extensive research has been conducted in the field of applied behavior analysis on feeding interventions for children with and without autism. Like any behavioral intervention, feeding interventions are specifically tailored to a child and his/her family to produce the best possible outcomes. An intervention that works for one child may not work for another. Additionally, there are several reasons why a child may not be eating and these reasons will vary from child to child. It is important to assess why a child is not eating (i.e., a medical or behavioral reason) before beginning an intervention. Feeding problems can involve many complex factors, and interventions to help children with feeding problems are by no means a one-size-fits-all situation.  This is when the help of specialists is crucial. Often, feeding interventions consist of a team of specialists which may include doctors, occupational therapists, speech therapists, nutritionists, and Board Certified Behavior Analysts. Caregivers, being a specialist in their child, are also a vital part of the feeding intervention team.

Caregivers may be resistant to feeding interventions and may have negative perceptions of what feeding interventions entail. Some may think feeding interventions consist of extremely aversive procedures, such as forcing a child to eat; however, there are several less intrusive interventions that have demonstrated successful results for a number of children.

Some interventions simply alter what is done before a meal begins to increase the likelihood that a child will eat (e.g., telling the child, “first dinner, then dessert,” creating a dinnertime routine, mixing a non-preferred food with a preferred food). Some children respond well to these less intrusive strategies, but some children require more intensive feeding interventions (Seubert, Fryling, Wallace, Jiminez, & Meier, 2014). Depending on the severity of the feeding problem, a feeding intervention can be a challenging and lengthy process; however, after a feeding intervention has been successfully implemented, the once unpleasant mealtime can become an enjoyable experience for both the child and his/her family.

In my own experience working with clients, I have had the opportunity to see many of the rewarding effects of feeding interventions. Here are a few examples of successes that can be achieved through intervention:

A child who only ate pureed foods received intensive intervention and began to eat the same meal as his family, smiling and laughing in the process. Another family could not eat at a restaurant because their child would scream, cry, and refuse to eat restaurant food; after slightly modifying their restaurant routine, the family could enjoy a relaxing meal together at a restaurant with their child eating food the restaurant served.

One particular selective eater refused to eat anything except chicken, which limited his ability to attend social events; more foods were slowly introduced to this child’s diet and eventually, he was able to eat many foods that were previously refused, including enjoying pizza and cake at a friend’s birthday party.  Growth and weight are a common concern of parents. I have seen a child who regularly refused to eat and was completely below the growth chart; after training her parents on a feeding intervention, she steadily gained weight and is now back on the growth chart and continuing to grow. It is important to keep in mind that all interventions are individualized, but these are just a few examples of the positive changes the right team and the right intervention can have for children and their families.

It is remarkable to see this difficult, daily routine become an enjoyable experience for those involved. Effective intervention for feeding problems can truly change the quality of life for our families.

If you have concerns about your child’s eating or food selection, speak to your child’s pediatrician.

 

Christine Seubert, M.S., BCBA

 

Seubert, C., Fryling, M. J., Wallace, M. D., Jiminez, A. R., and Meier, A. E. (2014). Antecedent interventions for pediatric feeding problems. Journal of Applied Behavior Analysis, 47,449-453.

Volkert, V. M. & Vaz, P. C. M. (2010). Recent studies on feeding problems in children with autism. Journal of Applied Behavior Analysis, 43,155-159.