Autism Classroom Helpers
Autism: Communication, Socialization, and Behavior
Communication and appropriate social behavior are inseparable, especially for a child with autism. Progress in these areas depends on development of strategies which will encourage and stimulate the development of the total child.
Inappropriate behavior may be caused by the inadequate development of communication. Conversely, behavior may be interfering with communication. Additionally, the inappropriate behavior may be the child's way of communicating. Without question, analysis of these factors will be the most important part of developing an effective treatment program. A Behavior Therapist and Speech Language Therapist working with the OT can all help greatly!
SUGGESTED STRATEGIES FOR CLASSROOMS:
Manipulate the environment - Initially, progress in individual goals may require that you to find a quiet place, devoid of interferences from visual distractions, where you can situate yourself and the child to encourage interaction and control stimuli. In the classroom, this is difficult at best. Consider a study carrel for certain times of the day and certain activities depending on the child’s needs. Position the child away from open windows, noises of the fan in the heating/cooling unit, and other visual and auditory distractions. The best placement will be near a hard-working child who can sometimes serve as a peer tutor or model for the child with autism. Avoid sensory triggers (e.g., mirrors, lights, loud noises) until they can be addressed in therapy. Analyze the classroom for ways to maximize success (e.g., chairs with side arms slow down the escape from the a desk or table!). You may want to position the classroom assistant in a chair on one side of the child initially and position the child’s chair next to a leg of a table, designating the boundaries and preventing a rapid impulsive run across the room.
Provide structure - Routines develop good habits. The child will learn to pick up toys, put away classroom supplies/books or perform other routine tasks if completion of the task is ensured daily as part of the structured routine. For example, try to develop the habit of the child only having the items needed for the subject on his desk during instruction and putting away all items after each subject is completed. Also, develop a routine for putting away papers which have been completed and papers which should be taken home for homework. A notebook system works well for this. Consider using pockets labeled clearly as "Done" (for younger children) or "Completed" or "Finished work" and "Homework."
Change the environment - Maintain consistent structure to build success, then build "tolerance to change" by systematically altering the daily schedule and managing any resultant behaviors. Changes can be effective in breaking a bad habit, as well. Look for antecedents of a behavior and change the schedule/ routine to reduce the likelihood of occurrence.
Take advantage of the schedule - Using visual cues (e.g., pictures, objects, written schedules), show the child what activities need to be completed and encourage the child to indicate the end of each activity by replacing the objects or representative pictures in a "done" box. This encourages task completion as a rewarding experience.
Structure for active participation - Waiting is difficult for the child with autism but can be taught. Initially, minimize the wait and reinforce "good waiting" by providing a high incentive activity after a short wait. Place a visual cue of the activity in view of the child during the wait. In classrooms, ensure that the child has frequent opportunities to respond. You may ask the child with autism to verbally respond or point etc. on one of 3 questions that you ask the class so that this child can continue to attend to the information. This will minimize waiting and will assist with focusing attention. During waiting times in the hallway or between subjects in the classroom, teach the child to participate in a quiet activity (e.g., looking at a book, playing with a small toy) while waiting.
Give a private retreat - Children with autism are often over-stimulated by their environment. Teach the child to retreat to a calm area when over-stimulated. The retreat can include a bean bag chair, favorite fidgets, massage mats, neck massagers, mini trampoline, weighted blanket, rocking chair, books, or soothing music. The classroom assistant will become adept at reading the signs that the child with autism needs to take a break. Eventually, the child will know on his/her own and will go there for a few minutes as needed.
Choose your battles - Decide important long-term goals for the development of socialization Remember that reduction of some self-stimulations may not be successful nor will the reduction always result in development of other good skills. Self stim is how the child self regulates and calms, taking this away can result in more screaming or worse self stim. Talk to the OT about how to replace self stim the right way with stronger sensory diet activities.
Don't try to extinguish ALL self-stims - Remember that if a self-stimulatory behavior is extinguished, it will probably be replaced by another. Think about whether the self-stim is tolerable or if it will call undue attention to the child. Prioritize!! Reduction of self-stimulatory behavior takes time and behavioral consistency. Remember that we all have odd mannerisms; try to replace the strange or irritating ones with tolerable ones. Look for toys that appropriately fill the child’s need for a certain type of stimulation. Use the sensory toy as an incentive to communicate or complete an activity.
Be consistent - The child is much more likely to be successful in the classroom if expectations for behavior and communication remain consistent between various caregivers and teachers. Later, the program can be varied to require different behaviors in different environments depending on the child's cognitive level.
Identify reinforcers/aversions - Be aware that a child may have more aversions than positive reinforcers initially. Reinforcement can be taught after the child's behavior starts to improve. Reinforcement initially may be the withdrawal of the aversion (e.g., completion of classroom work yields a break from work). Throughout this process, teach the child that he/she has "control" of people in the environment and can communicate (e.g., through a "no" head shake) to exercise that positive control. Develop the concept of grades over time so that the child views grades as a positive reinforcement. You may need to use a graph or chart to indicate the goal (i.e., grade in numbers or letters) and the actual grade received so that the child can track progress.
Use logical rewards/consequences - Punishment is rarely logically-connected with a behavior and may not encourage more appropriate responses. For example, if a child is sent to time out for not completing a task, he/she may actually be reinforced for the refusal to cooperate! The child actually "got out of" doing the task by going to time out. On the other hand, manipulating the child through the task may be aversive and would be a logical message of "If you don’t do as I asked, I will help." Most children with autism do not like physical assistance due to sensory factors. Therefore, the child will learn to comply to avoid the assistance.
Look for logical connections between communication and rewards. In the classroom, it is logical for a child to get free time when work is completed. It is logical for the child to receive praise for responding to questions in class.
Encourage positive control - Work toward "one try" of less desirable activities then reinforce with a preferred activity. Say "You can do it by yourself or I will help." to indicate that the child can determine whether or not the aversive "help" occurs. Teach the child to answer choice questions (e.g., Do you want _____ or _____?). Encourage self-talk as self-regulatory by giving sequential verbal cues with the same words each time you tell the child what to do (e.g., Get your cup. Sit at the table.). The child will begin to verbalize the same words as a self-cueing mechanism when confronted with the situation as practiced in his daily schedule.
Vary your tone of voice/body language - Initially, you may need to speak consistently in a calm and reassuring voice while working on behavioral compliance and to reduce tantrumming. Thereafter, be demonstrative in your emotions to ensure that there are no inconsistencies between your words and nonverbal communication. The child may comprehend your nonverbal communication more than the actual language; build comprehension of the language as you ensure consistency of all communication parameters.
Emphasize following directions and communication skills - Phrase directions in positive form (e.g., "Be quiet" vs. "Don't talk!") and help them know what to do rather than focusing on what NOT to do.
Say it once, then if no response, say it again as you physically cue the child to respond. Fade cues as quickly as possible. Teach reliable yes/no responses as a basic skill at all levels of development.
Provide physical assistance/nonverbal cues - If you can't ensure compliance, don't give the direction. Remember that the child will only learn to comprehend and comply with requests based on following the direction when you give it. Fade the physical cues as quickly as possible.
Successful techniques - Use a variety of methods and materials so that skills are likely to generalize. Repetition is not bad (in fact, it HELPS!) but most skills should not be considered mastered until they have been observed in more than one situation and with more than one person. Be aware of the amount of stimulation you are providing and reduce or increase as needed.
Choosing goals / activities - Seldom will you be working on one skill without tapping into others. Be aware that activities such as "sorting shapes" work on visual motor, shape concepts, receptive language, expressive language, attention, and compliance. If the child cannot do an activity in the way that it has been listed as a goal, analyze the breakdown. For example, he may be able to sort shapes, but have a short attention span requiring you to cue each attempt.
Children with autism often show an early interest in letters or numbers. Use this interest to develop meaningful activities. The development of early reading skills is helpful as a cueing system for teaching a child to communicate.
"Up the ante" - In deciding on a mode of communication, use all possible avenues. Structure for verbal, provide opportunities to sign/gesture, and allow use of communication devices and pictures as appropriate. Research shows that use of an alternative system does not interfere with development of verbal communication. Remember that you may be working with a child that has NO means of communication. Communicating in any way is a priority. Communicating through negative behavior is merely an indication that the child wants to communicate and has no better system.
Create opportunities to communicate - Having identified high incentives and structured the environment, you will be ready to create some scripts for communication. In the classroom, these may be words or phrases that are consistently paired with an activity or action within the schedule. Hearing you consistently verbalize the sound or action, the child will come to expect the occurrence. Once the sound/word is part of the routine, delay verbalizing and the child will often "fill-in" the expected verbal part of the routine. Remember that we are not concerned with the accuracy of the production initially. The attempt to communicate is the most important!!
Involve others - As soon as you gain compliance in therapy, involve others in the activities. Development of social interaction should always be a priority.