Notes from the November 10, 2011 Autism Support Group: AUTISM ACCOMMODATIONS AT HOME

Amy, creator of our new blog, taught at our November Autism Support Group about Autism Accommodations parents can make at home.  There is a LOT of GREAT information in this post that can be really helpful to parents.  Thanks Amy!

 Autism Accommodations At Home

Some general principles to keep in mind when deciding on accommodations:

Set goals. Goals should be specific and measurable.

·         Long term: Have a vision of what you’re aiming for over the long haul.

·         Middle range: Break the big picture down into specific skills or behaviors to target for the next few weeks or months

·         Short term: Break each skill or behavior down into the most basic elements. Which steps can your child do now? What is the NEXT step he or she needs to learn? –OR—what is the NEXT step better for the target behavior? (Build bridges one plank at a time for your child; don’t demand that he leap gaping chasms in a single bound.)

Prioritize.  Focusing on a specific target gets better results than a random shotgun approach

Set your own priorities your own way, but here are some possible categories to think about:

A)     Top Priority: Behaviors that pose a safety risk. Skills that are critical to survival.

B)      Medium Priority: Behaviors that are causing major disruptions in family life or school. Skills that are important for the child to become a productive member of society.

C)      Low Priority: Behaviors that are weird and annoying, but not dangerous or overly disruptive. Skills that it would be nice for your child to gain, but which are not essential to a happy life.

·         Which three skills are most important for your child to learn next?

·         Which three behaviors are most important to work on now?

·         What safety measures, accommodations, or compromises can be put in place to help you, your child, and your family live with the issues you’re not currently working on?

When you put an accommodation in place, think about:

·         Specifically, what is the purpose of this accommodation? What behavior or skill is it intended to address?

·         How does this accommodation meet the need?

·         What is the desired outcome of the accommodation? How will you know if the accommodation is successful or not?

·         What is a reasonable period of time to try this accommodation to see if it results in the desired outcome?

·         Who will be responsible for seeing that the accommodation is carried out?

·         How will this accommodation affect the relationship between you and your child (and other family members)?

It’s ok if your accommodation isn’t a success. Even the failures will give you new information about your child that will help you formulate future accommodations more successfully. Just re-evaluate, regroup, and try something else. You have your whole life ahead of you, you don’t have to fix everything this afternoon. Trust me, the autism will still be there tomorrow.

Sensory

Remember that kids can be hyper-sensitive, hypo-sensitive, or swing back and forth along the whole spectrum of sensitivity. Adjust sensory accommodations accordingly. Sometimes kids need less stimulation to avoid becoming overwhelmed, but sometimes they need more stimulation to keep themselves oriented and connected.

Consider assembling a “Sensory First Aid Kit” to take along when you go places. It might include things like sunglasses, ear plugs, chewing gum, rubber gloves and/or wipes, a favorite snack, a fidget toy, a soft brush, etc., as appropriate for YOUR child’s sensory needs. When your child is in sensory distress it’s nice to have some tools to try to help, and older kids can learn to self-“medicate” and may feel less anxious if they know they have their toolkit along.

Vision

·         Evaluate lighting. Lighting that is too bright can cause some children distress. Fluorescent lighting can seem to flicker like a strobe light for some children.

·         Colors – Intense colors, pure, bright tones, and  “warm colors” (reds, pinks, yellows, oranges, etc.) are often more stimulating to the nervous system. Pastel colors, greyed tones, and “cool colors” (blues, greens, violets) are generally more soothing. Choose colors for walls, furniture, bedding, clothing, etc. that will be appropriate for your child’s needs. Bright primary colors are popular for kids, but may be over stimulating for autistic children.

·         Patterns – stripes, dots, plaids, paisleys, etc. are fun, but too many can overwhelm a sensitive nervous system. Words or pictures on clothing can also be over stimulating. Opt for plain colors or minimal patterns, especially close to the face or in frequently used areas.

·         Clutter can be visually stimulating. Keeping things tidy can help a visually sensitive child stay regulated. Putting doors or curtains on shelf units and cupboards can also reduce visual clutter.

·         Sunglasses and hats can help with bright lights outdoors. Look for close-fitting “wrap-around” sunglasses that control light on the sides and top as well as just looking forward.

·         Movement –  rapid, repetitive motion can be stimulating to the nervous system. Slow, gentle, deliberate motion is more soothing. Sometimes your child needs you to just be still. Mobiles and wind chimes can provide additional stimulation, as can TV and computer screens.

·         Sensitive kids can have a hard time filtering out peripheral stimulation, which can act cumulatively on the nervous system. Sometimes a dim, clutter-free area with a door that closes can be a big help for oversensitive kids.

Hearing

·         Pay attention to background noise—all the sounds you don’t normally “hear” because your brain filters them out—heating and air conditioning, buzzing lighting, creaky floors, wind, birds or traffic outside, your own breathing, people talking in the hallway or next room over. It can add up really fast.

·         Limit the number of sound sources going on at once in your home. The radio OR the tv OR the computer; not all of them at once.

·         Headphones. Play music or stories in headphones for your child to help drown out the constant auditory “clutter” of background noise. Have other family members use headphones when using the computer or listening to their music. Run the washer and dryer when your child is at school (or wait until he’s home if the additional stimulation is soothing; a running dryer at bedtime can work wonders.)

·         Ear plugs and ear protectors can be helpful for times when the child can’t withdraw from the noisy environment. These are available in several forms, which vary in effectiveness.

·         A quiet room where the child can go and close the door can be a life-saver.

·         A rambunctious, shouting, fidgeting, noisy child might be an under-stimulated child. Putting on a little quiet music can do a lot to cut down weird “sound effects”, repetition of random words, a child talking to him- or herself, and other bothersome auditory behaviors.

·         One odd thing that can happen when a child’s hearing is severely overstimulated is that it can shut off to protect the system. (This can happen with other senses too, but I’ve heard about it most with hearing.) If your child seems to be ignoring you it might be a sensory shut-down, not intentional rudeness. Usually, getting the child’s attention through another sense is enough to restart the auditory system. Before getting angry try touching the child’s shoulder, or standing in his line of vision, and then try talking again.

·         Monitor your voice. It can be easy to raise the volume, pitch, and intensity of your voice when you are frustrated, but this might just make the problem worse if your child is already overstimulated. Practice speaking in a calm, slow, even, quiet voice, especially when your emotions are running high. Conversely, speaking in a more rapid, intense manner when your child needs to be energized can help get things moving.

·         Set aside a quiet space and/or time for homework. It can be especially hard to focus on studies with noisy siblings, pets, dinner preparation, etc.

Touch

·         Remember that light touch and deep pressure are handled through two different sets of nerves. A child who likes to ram into things might find a pat on the back uncomfortable, or even painful—and vice versa. 

·         Certain textures can be irritating and over stimulating. Choose soft fabrics for clothing, bedding, etc. 

·         Cut tags out of clothes, or look for tagless items. Get socks without seams. 

·         Sleeve length can be a big issue. Some kids find the constant stimulation of constant skin contact that they get with long sleeves calming and reassuring. Other kids find long sleeves too over stimulating and are better able to stay regulated if they have short sleeves so nothing is touching their skin. 

·         Some kids are calmer with very tight clothing. “Rash guards”, or other close-fitting lycra clothing can be worn under regular clothing to provide the pressure they need to stay calm. Other kids do better with very loose-fitting clothing that minimizes skin contact.  

·         Give the child rubber gloves to wear when working with things that are sticky or messy.  

·         Experiment with different kinds of personal care items such as combs, brushes, toothbrushes, etc. Some kids like the stimulation of stiff brush bristles, but others need softer contact on their sensitive scalps. 

·         Try out different kinds of soap. A slimy bar of soap might send some kids over the edge. They might do better with liquid or foaming soap. Some kids do well with a bar of soap in a cloth cover.  

·         Pressure from a weighted vest or blanket can be soothing to some children. Other kinds of deep pressure might also be soothing. Be creative—let the child climb behind the back cushions of the couch while you lean against the cushions, give “bear” hugs, wrap child tightly in a blanket, etc. (SAFETY FIRST!!) 

·         If your child finds specific textures calming, consider ways he can take the texture with him for moments of distress—a scrap of flannel fabric in his pocket, a special stuffed animal in his backpack, a smooth “worry stone”, a squishy ball, a nubby teething toy to rub with his fingers, etc.  

·         Some kids are soothed by “brushing” their skin with a soft-bristle brush. 

·         Temperature can also be an issue. If your child is in distress a heating pad or cold compress might help. 

·         Provide items it’s ok for the child to chew or suck on to meet oral tactile stimulation needs. Teething toys, water tubing, lollipops, gum, etc. Search on the internet for “chewelry” to find sturdy bracelets, necklaces, etc.  made specifically for chewing on. 

·         Allow a picky eater to “play” with his food with his fingers. Sometimes it feels “safer” to explore new food textures with the fingers before putting them in an over sensitive mouth.

Taste

·         Try cooking foods with little or no seasoning, and allow family members to add seasoning at the table if they prefer.

·         Allow the child to take only ONE bite of a new food. Praise him for trying, even if he gags or spits it out. Then give him a preferred meal. (If one bite is too much, let him hold it, or smell it, or lick it—whatever level of exposure he can tolerate—and reward that.)

·         Provide distractions while the child is eating—conversation, music, pictures, a toy to play with, etc.

·         Give the child some control whenever possible. Ask him which of two new foods he would like to try. Let him choose which item on his plate he will eat first.

·         Set up a sticker chart or other reward system for the number of bites eaten, number of new foods tried, etc. as appropriate for YOUR child.

·         When you find a food that is particularly successful, try variations of the same food—a different brand of frozen pizza, same brand but different toppings, a different flavor of sauce, pizza bagels, pizza rolls, etc. This will help expand tolerated flavors gradually.

·         Give the child an ice cube or popsicle to suck on before trying a new food. The cold will help desensitize their mouth temporarily so the new flavor is less intense at first.

·         Allow condiments and sauces—whatever it takes to get the food down. When the food is tolerated well with the condiments, you can start to fade the condiments by adding less each time.

·         If your child is also sensitive to textures, try adding either a new flavor OR a new texture, but not both at the same time. For example, if your child does ok with smooth textures but gags on chunky items, puree new foods the first few times it’s offered.

·         Cut food into fun shapes with cookie cutters.

·         Toothpaste. Try different flavors. Allow child to clean tongue and gums with plain water, then use toothpaste on just the teeth.

·         Praise ANY progress. If they played with it, smelled it, licked it, chewed it and spit it out, swallowed it (with or without gagging)—whatever the NEXT step is for YOUR child with THAT food—praise it to the heavens. Don’t embarrass or criticize the child for food failures.

Smell

·         Choose air fresheners wisely, or avoid them altogether 

·         Look for unscented or lightly scented options for cleaners and laundry detergents.  

·         Make fragrance (or lack thereof) a priority when choosing personal care items such as lotions, deodorants, shampoo, toothpaste, shaving cream, etc. This goes for all family members if your child is very sensitive.  

·         Some children find certain scents very soothing. If you have one of these, experiment with essential oils and other aromatherapy products.  

Spatial Awareness

·         Weighted vests, blankets, or lap pads can help the child feel anchored.

·         Allow child to trail a hand along a wall as he walks.

·         An inflatable “wiggle seat” cushion on his chair can provide more sensory input from joints and help him stay in his seat.

·         If your child has a poor sense of direction a handheld GPS device can help him feel safer walking to school or a friend’s house.

·         At bedtime, wrap your child tightly in a blanket, have him sleep in a sleeping bag, add extra pillows or stuffed animals to his bed (to give him additional spatial reference points). Consider hanging curtains around the bed (works well with bunk beds) or setting up a small tent for your child to sleep in.

·         A child with spatial sensory issues might enjoy a small, enclosed cubbyhole somewhere to play or read in.

·         Teach child about honoring other people’s “personal space”. Give specific guidelines about how much room he needs to leave between his face or body and the other person’s (a hula hoop is a good way to help him visualize, or an arm’s length).

Physical coordination

·         Choose individual sports and activities where a child’s performance is measured against his own past ability level, and not compared to the rest of the team.

·         Shoes with Velcro fasteners are a good option for kids who have trouble tying shoelaces.

·         Allow extra time for tasks requiring physical coordination.

·         Break down new physical skills into the smallest possible increments, and teach one step at a time. Practice the first step a lot before teaching the next one. Praise for every little bit of improvement, no matter how small.

·         If handwriting is a problem, teach the child to type.

 

Emotional

·         “Live out loud”. As often as you can, keep up a running monologue of what is going on with your own emotions. Label and describe your emotions and talk about why you’re feeling what you’re feeling and how another person might be able to tell what you’re feeling, as well as how you are managing your emotions so they don’t take control of you. “I was so startled (label) when that glass slipped out of my fingers, because I was not expecting that to happen (why). When I’m startled all my muscles tense up, my eyes get big, and sometimes I gulp in a fast, deep breath of air (description of physical markers of the emotion). Patting my chest and taking slow, deep breaths helps me not be so startled (management technique). Whew! I am sure relieved  that the glass didn’t break on the floor. That’s why my body relaxed, and I let out that huge sigh.” And so forth.

·         Help the child recognize and label his own emotions and their markers. “Right now you seem to be feeling very frustrated. I can tell because your eyebrows are scrunched down in the middle and you’re jumping up and down and yelling.” Or, “You seem so sleepy! Look at that big yawn and those droopy eyes.”

·         When the child can recognize basic emotions, teach the child to recognize and be aware of different LEVELS of those emotions. A number rating system can be useful. Use this in your “living out loud” monologues. “I’m feeling happy. I think I’m happy at about a level three.” Or, “I am running out of patience! I am frustrated with you at a level five!” Then you can teach different labels for different levels, such as content (1), cheerful (2), happy (3), thrilled (4), and overjoyed (5).

·         Teach the child specific techniques for regaining control of emotions that are starting to get out of hand. If he can recognize that he is frustrated or frightened at a level three and start deep breathing, or visualizing something pleasant, or looking for an exit, he can regain control before he is too far gone to think straight.

Learn to tell the difference between a tantrum and a “meltdown”. During a meltdown remain calm, move slowly and deliberately if at all, if you must speak do so quietly. Keep the child and others safe, and wait until it passes. When a child is in a meltdown the part of his brain that handles language, logic, and reasoning (cortex) has shut down, and the non-verbal emotional centers (amygdalae) have taken over—this is an instinctive “fight, flight, or flee” response, and he is unable to think rationally. After the meltdown has ended, allow everyone a little time to regroup and rest, then talk about what happened and what you and the child can each do differently the next time to get a better outcome. Don’t punish or criticize for “meltdowns”. If your child had an asthma attack you wouldn’t scold him and tell him he’d better start breathing properly or you’re going to take away his Play Station. You wouldn’t tell him that if he has one more asthma attack this week he will lose his computer privileges for a month. You would give the proper medication, and then do your best to figure out his triggers and either avoid or prepare for them. Think of a meltdown as an asthma attack of the nervous system. Your child needs help, not discipline. (Temper tantrums are another story.)

Organization / Planning

·         Post a daily routine, and mark off each item as it’s completed. Generally it works best to list just the order of events without tying them to a specific time of day, unless there’s an actual deadline (like leaving for school at 8:00).  You don’t want your child to obsess about taking exactly five minutes to brush his teeth—or refuse to brush them at all because it is 8:31 and the schedule says 8:30. Use pictures for kids who aren’t reading yet. Consider using cards stuck to a Velcro strip, or magnets on a magnet board. This will allow you to change the routine if needed, and will give your child a way to visualize and anticipate what’s coming next so he isn’t caught off guard by something unexpected.

·         Post a family calendar where kids can see visually what non-routine events will happen each day, and how long it is until an anticipated (or dreaded) event.

·         Have a specific place in your home for each task that comes up regularly—a homework station, a toothbrushing station, a getting dressed station, a mealtime station, etc. (You don’t have to call them stations.) In each area keep all tools that are needed for the task(s) that are performed in that area. (Pencils, crayons, a ruler, etc. in the homework corner. Toothbrush, toothpaste, and floss in a basket on the bathroom counter. A hairbrush, detangle spray, and ponytail elastics in another bin.) Consider posting instructions for the tasks that take place there (How to Take a Bath: Step 1 – get out a towel. Step 2 – make sure you have soap and shampoo. Step 3 – Choos 1 bath toy. Step 4 – turn on the water and adjust the temperature….and so forth.)

·         Check your child’s backpack. Don’t count on him to remember to give you notes from school. Consider having a notebook to pass back and forth between you and the child’s teacher to make sure you always know if your child needs to bring something unusual to school or if something upsetting happened that day that you need to talk about with your child, AND so your child’s teacher can be forewarned if your child is starting out the day a little “off” because you didn’t have the right kind of cereal, or his blue shirt is in the wash or whatever.

·         A timer is your friend. Using a timer helps transitions go more smoothly:  I am setting the timer for five minutes. When the timer rings we will put on our coats and get in the car. A timer can help keep a child on task: Work really hard for five minutes, and when the timer rings you can stop. Or it can provide motivation: Last time it took you twelve minutes to finish; I’ll set the timer for twelve minutes this time, and let’s see if you can do it even faster.

Social / Relationship

·         “Live out loud”. Keep up a running monologue about why you do what you do, what you hope the result will be, what you will do if the result is different from what you expected, how you feel about a task, a person, an event, etc., and how that affects your choices. This gives your child a window into how another person organizes their thoughts and relates to other people and the world around them. It provides a model on which your child can organize and deal with his own “inner world”. Be as open and honest as you can, and include the “ugly” bits. Your child needs to know how to deal with that stuff too. “Oh I am SO EMBARRASSED. I feel like crying. I feel like everyone is staring at me. I want to crawl in a hole and disappear. But I can’t do that because I have too many responsibilities. And also it’s impossible to just disappear. So I am going to….” Or, “We’re going to see Aunt Mary. I’m not really looking forward to seeing Aunt Mary because she smells funny and always criticizes how I look. But Aunt Mary is Dad’s big sister. I love Dad, and I want to make him happy, and I know it makes him happy when I am nice to his sister, so we’re going to go visit, and I’m going to smile a lot and try not to breathe too deeply. But don’t tell her, ok? It would probably embarrass her if she knew I thought she smelled funny, and I don’t want to hurt her feelings. I don’t like it when people hurt my feelings.”

·         Balance your life. Sometimes just “being a family” is more important to your child’s wellbeing than a particular therapy opportunity. You and your child both have limits on your time and energy. Budget them wisely.

·         Speak respectfully to your child. Talk to your child in the same tone, and with the same words with which you want him to speak to you. Say please and thank you. Use your inside voice. No swearing. If you don’t want your child to make requests in the form of a demand, you don’t do it either. It WILL come back to bite you. If you want him to jump up right away and comply with a reasonable request, that’s what you need to do too. Think of it as an investment in what goes around comes around. (Remember the GIGO principle—Garbage In, Garbage Out.)

·         Be flexible. Your child learns flexibility by living with it. (Live your flexibility out loud: “I don’t want to X, but I know I need to be flexible, so I will do this much if you will do that part.”) Your child can’t learn flexibility by watching you be rigid.

·         Be sensitive to how much social interaction your child likes and/or can tolerate. It may be less than you think he should like and/or tolerate, but it’s HIS social life—not yours, not his brother’s, not his cousin’s, or the neighbor kid’s. Don’t take him to the Christmas party “so he’ll have pleasant memories of childhood” if it isn’t going to be a pleasant memory for him.

·         Talk your child through upcoming social situations. What will it be like, who will be there, what will be expected of him, what should he say, where he can go if he needs a break.  Help him learn some general, all-purpose “scripts” for use in social settings. “Hi, how are you?” The person will respond—if it’s a happy response, you can say, “That’s great! Well, it was nice talking to you.” And then you can leave. If it’s an unhappy response you can say, “Oh I’m sorry to hear that. Well, it was good to see you.” And then leave. No fuss, no muss, no stressful “conversations”. Teach scripts for things like starting and ending conversations, asking for help, greetings and farewells, making a phone call, answering a phone call, and other common situations where we all kind of operate according to social scripts anyway. “Social Stories” and roleplaying can help a child know what to expect and what is expected of him.

·         When you enter a new social setting, try to help your child identify a “safe place” he can go if he becomes distressed. Take him to the “safe place” so he knows where it is, and let him know he can go there if he feels anxious or upset. Knowing what to do in case of emotional emergencies can help the child feel less anxious and lessen the chances of a problem, gives him the opportunity to practice self-regulating, and helps you know where to find him if he bolts. It can also be helpful to locate restrooms and drinking fountains in advance.

·         Explain the obvious. In detail. Repeatedly. No question is a dumb question. Pretend your child is a visiting dignitary from another planet, and it’s your job to explain Earth culture.

·         Allow extra time for social responses. Count to 10 (or 50) in your head if necessary.

·         Make your relationship with your child a high priority. Your parent/child relationship will last a lot longer than one awkward, embarrassing, or frustrating incident. Don’t let a 5-minute incident ruin a lifetime relationship. Be on his “side” whenever possible. Give him the benefit of the doubt. Praise as much as possible. Criticize as little, and as kindly as possible. Be his biggest fan, and his loudest cheerleader—even when you don’t feel like it. Tell him you love him just as he is—and mean it. Try to have at least 4 positive interactions with your child for every negative interaction; you will be amazed what a difference it will make.

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