Temple Grandin

Equally noted for her work on autism and animal husbandry, Dr. Temple Grandin is a visionary in more than the traditional sense. Diagnosed with autism in 1950 at the age of 2, Grandin has utilized the “wiring in her brain” to see things the way that animals do. Over the past 25 years her insights have literally revolutionized animal husbandry in the cattle industry.

She also works as an Autism activist. Based on her own experience, she advocates for early intervention and ABA therapy. She also thinks that every child with autism needs a mentor who can use child's fixations for teaching skills. She talks about autism and its treatments in TV shows, conferences and seminars, and also give interviews. Following is a her video on TED talk -

"Autism activist Temple Grandin talks about how her mind works -- sharing her ability to "think in pictures," which helps her solve problems that neurotypical brains might miss. She makes the case that the world needs people on the autism spectrum: visual thinkers, pattern thinkers, verbal thinkers, and all kinds of smart geeky kids."

Slow down, take a breath, and share the moment!

When I work with my son, sometimes I lose my patience. What is this? He doesn't want to listen. He doesn't want to comply or perform tasks. He has become very much resistant and oppositional. He doesn't want to do anything at all. He avoids me when I ask him to do any task. But it's not that he has not understood the instructions, but he doesn't want to do at any cost. And when I am in hurry and I have something in my mind, I just want him to finish the task. Reading this post on Autism Discussion Page, I realized that what's going wrong. I have to slow down myself to make him comfortable. The task performance should not be important than his comfort. I want him to learn things naturally.

Slow down, take a breath, and share the moment!

Parenting a child with autism often means wearing multiple hats (mother, father, therapist, teacher, researcher, advocate, social mediator, biomedical doctor, etc.). You have to continually multi-task to keep up with the chaos. Parents of young children on the spectrum often have an overwhelming sense of urgency, to do as much as possible to help their child overcome their challenges and develop and grow to their maximum potential. This is very understandable and recognizable in many parents of young children. However, we have found that often we move too fast in our urgency to provide for our children. The world moves way too fast for these children, and we need to slow it down to maximize learning.

The world moves too fast for children on the spectrum. They have trouble processing multiple information at one time, and tend to have problems with delayed processing. Because of this, our world simply moves way too fast for them. Slow things down and savor the moment. Pause to let them process and think! Take little things in the day and slow them down, highlighting the important details, so they can reference the important things. When using language with children on the spectrum, there are three important factors.

1. Slow it down and use shorten your sentences. Speak in two to three word phrases if the child only speaks in short phrases. It makes it easier for them to process. The longer the sentence the more jumbled the information becomes. Use only as long of sentences that the child uses in return. However, even for very verbal children, shorten sentences makes it easier for them to process.

2. Use less words and more nonverbal language (exaggerated gestures and animated expressions) to communicate. Most of the children process better visually then they do auditory. In addition, it gets the child referencing your nonverbal language for information. Children on the spectrum will usually listen to your words without referencing you visually for information. This is one reason why they have a hard time reading body language. Slow it down and use more exaggerated gestures and animated facial expressions to convey meaning. When the child starts to forget to reference your nonverbal language, you simply pause the activity until he references you again. Once he picks this up, he will start to reference you more naturally.

3. When using words, use more "declarative language" instead of "imperative language." Imperative language is any statements that direct a specific response from a child (questions, directives, instructions, prompts, etc.). Declaratives are any statements that invite, but do not direct a specific response from the child (statements share information, ideas, thoughts, feelings, experiences and perspectives). Normal interaction between two people usually consist of about 20% imperative (questioning, directing) and 80% declaratives (sharing ideas and information). However, when we interact with children on the spectrum the ratio is turned around; usually 80% imperative and 20% declaratives. Children on the spectrum tend to freeze up and resist imperative language. They tend to have strong "performance anxiety" and pull back from imperative (directive language). Just like us, no one likes to be questioned, prompted, directed all the time. In our experiences with families, changing (rephrasing) our language is probably the strongest tool we find. It is as simple as changing our language from "John, what is the matter?" to a descriptive statement like "Wow Johnny, you really look upset to me!". You will find your child providing much more information. Try it on your teenager when he comes home from school. Instead of saying "How did your day go?" (which usually gets one word "fine"), try "You look like you had a good day today (or bad one)" and watch the kind of reaction you get. Usually the child will go into much more detail. We find that we usually get three times more interaction from the child when we use declarative language.

4. Learn to pause and wait! Children with delayed processing need time to respond. They have to process what is coming in, appraise what is needed, and formulate how to respond back. In our haste we often jump in and continue to prompt, or respond for them. Waiting is the hardest thing to do. It is much slower than our nervous systems want to wait for. It tasks patience and practice, but is very important. Slow it down, and give them a chance!

Signs of Autism

Look At Yourself

That's why I like the page Autism Discussion Page. Bill Nason, owner of the page, explains everything so nicely and so intensely that I feel somebody is guiding me and there is someone who can understand me and my child better. He knows everything and can discuss on any aspect of autism. When I am frustrated and stressed, I read his page and feel supported and relaxed. When I talk to my husband, I always refer this page. He asked me whether I am fan of this page. Yes, I am a big fan of Autism Discussion Page.

Look at yourself in the mirror and smile

At the end of the day, as you drag yourself to bed, look in the mirror and smile! You made it through another day. Regardless of the challenges that were presented, how much you feel you accomplished or didn’t complete, you made it through another day protecting your family, advocating for their needs, and scaffolding this chaotic world for your child. You may feel completely exhausted, that you are defeated, like you said and did everything wrong, and left behind a million things you have left to do! However, if your family is safe, protected, and receiving your love, you have had a successful day! 

Between running between therapies, meeting with professionals, advocating at school, dealing with a meltdown in the middle of Kmart, arguing with a family member who feels that you are parenting wrong, chasing your child as he escapes down the block, and watching as your child changes clothes twenty times before he finds the one outfit that feels comfortable, you may not feel like a success! Believe me, most parents of children with special needs are super human! They take on more challenges and stress, and have to multitask more than any other parents. It is a new battle everyday and you tackle them as a passionate soldier! You enter challenges for which people do not have answers. You are often alone, facing challenges that most of us would run away from. Why do you do it? You have no choice! You are your child’s voice, protector, mentor, source of love, and the only one who truly knows him. You are his link to the world, and with every day that passes, you have served that role with honor and passion. So look at that face in the mirror each night and smile! You are one awesome person!!

Emotional engagement

Earlier, I have posted few posts from the Facebook page Autism Discussion Page" and I found that every parent / caregiver / therapist or any autism professional must read this page. I know, dealing with autistic people (kids and adults) is very tough task, but with a good understanding and strategy we can reach to their hearts. 

Emotional engagement with severely impaired adults!

I have the privilege of consulting with many individuals that have severe impairments and multiple behavior challenges. They are often either living in institutions or community group homes. I used the exact same principles to teach "safety" in my presence, and trust in my interaction. I start where they are at, identify their interests and comfort zones, and take what little leverage they give me to teach social engagement.

One individual, I had the pleasure of meeting, was very aggressive and required one on one staffing to be within six feet of him at all times, to protect himself and others from being hurt. His name was Eric. Most interactions between staff and Eric were instrumental in nature (directions, prompts to do things, or not to do something). Eric did not feel connected with staff, so obviously did not feel safe and accepted by them. He had to control all interaction and activity around him to feel safe and predictable. Eric would typically refuse to engage with staff or comply with daily activities. He wanted to be left alone to engage in self stimulation most of the day.

When I first met Eric, I ask staff what he initiated on his own that he enjoyed doing. The only thing that staff could come up with was "ripping magazines." He enjoyed ripping pieces of pages in magazines and then dropping them in a pile on the floor. When I asked staff if he does this a lot, they reported “no”, because they keep magazines away from him. Since this behavior of ripping was not the “norm”, they defined it as being destructive, and found it to be problematic. Unfortunately, staff did not see this as a strong interest that they could use to establish an emotional bond with Eric. This behavior gave me a self-directed interest for this young man, that I could use to create engagement (we-do activity) around.

I sat down next to Eric, introduced myself, and put my hand out to shake hands. He refused. I shared that I had heard that he was good at ripping magazines and that I would like to see him do it. I gave him a magazine and allowed him to start ripping, perfectly straight, narrow pieces off the pages. I marveled and commented on how well he could do that, and expressed interest in doing it myself. I started slowly ripping paper right in front of him, face to face, within easy vision for him to reference me. As he ripped, I imitated him, animating how I was trying to do it as well as him. I would drop my pieces on the same pile as his. I commented on how well it felt to rip the pages, and he would look up at me like I was weird! Periodically I would reach out my hand in gesture of acceptance and he would gradually reach out and lightly touch mine. I continued to follow his lead, imitate what he was doing, and celebrate with words of acceptance and frequent give "five." 

After several minutes of this, he seemed to feel comfortable with this level of engagement, so I decided to throw in a variation, to stretch his comfort zone. I put my magazine down and asked him if we could rip together. I slowly reached over and started a small rip at the top of the page, and motioned for him to finish ripping it. He looked a little anxious, but followed my lead. We proceeded to tear and rip together, me starting the tear, and him finishing it, then dropping into our pile. Now we had back and forth interaction, with both of us playing an active role in ripping. I would invite him to celebrate after every three or four rips by putting out my hand for him to reach out and give me five. I continued to give animated emotional expressions that I enjoyed sharing this experience with him. A couple of times he smiled. We were using an activity that he felt comfortable with and enjoyed doing, to build reciprocal engagement around. 

Next I wanted to see if I could expand on this activity. I wanted to get him up to a table to rip there, but felt he might be hesitant to move to the table. I had staff place out two glasses of pop (which is his favorite drink). We went to the table and shared drinking pop together as I commented on how much fun I was having ripping magazines with him. I decided to try expanding it to making a collage of the bits of paper that he ripped from the magazine. As he ripped a piece of the magazine I would paste it onto poster board to make the collage. He seemed to find that interesting that we could use the pieces of page for something after he ripped it. He ripped, and I pasted, sharing the experience, and frequently celebrating with "give fives" and emotion sharing. Next, he would rip, I would put glue on the piece, and give it back to him to paste on the board. We filled up the paper and hung the collage on the wall, commenting on how nice it looked, and celebrating as usual. 

In a matter of about 40 minutes, we had established a social connection together, around an interest that people were typically defining as bad and limiting his opportunities for ripping. I had started where he was at, engaged myself into an activity of interest for him, let him initially lead, while I imitated his action, and frequently celebrated with "give fives" and emotion sharing. Once he felt comfortable with that I expanded on the activity by adding variations to it. This resulted in co-regulating back and forth interaction, where we helped each other in completing the collage together. This was a real eye opener for staff to see that the avenue to socially connect with him was validating and engaging in the sensory preference (ripping) that he found rewarding. From there the staff were given directions to bring in all the old magazines they could find and do this activity at least twice a day to build a social connection with him. Over time both this young man and staff started to feel more comfortable and connected with each other, and eventually expanded the "we-do" activities into a number of reciprocal, interactive activities together.

Differences between Tics, Compulsive Behavior, and Self Stimulation

Here is another post from "Autism Discussion Page". It's a nice explanation of different behaviors shown by kids with autism. -

Differences between Tics, Compulsive Behavior, and Self Stimulation

Are your child’s repetitive behaviors tics, compulsive behaviors, or self stimulation? The repetitive behaviors in all three conditions serve different functions. Tics are a neurologically driven, often involuntary. They can be very jerky, not a smooth rhythmic pattern, and often involuntary. They usually involve motor musclegroups (eye blinking, facial twitching, etc.) or vocal noises, sniffing, throat clearing, or snorting type patterns. Usually the child has multiple motor patterns, and at least one vocal tic. They seem to serve no functional purpose for the child. The child may feel the “urge” coming on, but have very difficult time stopping them. The child do not enjoy the tics, and often feels frustrated in not being able to control them.

A true “compulsive behavior” (as compared to a fixation) is driven by anxiety and often result from “obsessive thoughts”. The person feels driven to do it because of anxiety and will become more anxious if you block it's occurrence. They are aware of and have some control over the behavior, but feel “compelled” to do it, and feel very anxious if they don't do it. They often do not feel good, the child is driven to do it, because they feel anxious if they don’t. The disorder can consist of strong repetitive obsessive thought patterns (intense worries, exaggerated fears, etc.), compulsive behavior patterns (washing hands over and over, repeatedly opening and shutting doors, compulsive orderliness, etc.), or both.

Self stimulation is a more voluntary, controlled sensory seeking to calm and organize the nervous system. These repetitive behavior is used to sooth and calm the nervous system when over-aroused, alert the nervous system when under-aroused, and block out unwanted stimulation when overwhelmed. They usually consist of repetitive “rhythmic” movement, auditory, or visual patterns. Self stimulation is usually a voluntary pattern the child uses to help regulate their nervous system. Usually if the repetitive pattern, is rhythmic in nature, and feels good, it is not tics or OCD, but self stimulatory.

Do you think I am having fun!

Such a nice post from "Autism Discussion Page". Reading this, I myself realize that how sometimes working with my son, I start to control him instead of supporting him. We all love our kids. We want them to learn all the skills, but sometimes we forget that they can not learn forcefully until unless they are interested in the activity. -

“Do you think I am having fun!” From the child’s perspective! 

“Do you think I am having fun when I scream, fall to the floor and slam my head repeatedly?”

“Do you think I am enjoying it when I meltdown in the middle of a classroom with my peers staring at me?”

“Do you think I am having fun when I cannot sit still, and am running around the room, bouncing off the walls, ignoring your assistance?”

“Do you think I am having fun when I am staring into space, with glassy eyes, and turning away to block you out because I am overwhelmed and shutting down?”

“Do you think I am having fun when I repeatedly hit my face with my fists until all the frustration is gone?”

“Do you think that I enjoy hitting, kicking, and biting you when I love you?”

When I hear people discussing my behavior, what is there that leads them to believe that I like to do this; that I find enjoyment in creating havoc, stress, and anxiety for myself and others? Do you think I would do this if I had more adaptive ways of dealing with the problem? When I am continually acting out to gain your attention, you say I am “seeking attention” (like I like it) and put me on extinction. Do you ever think about “why” am I needing constant attention in the first place. Why am I acting inappropriately to obtain attention? Instead of ignoring me, try and listen and understand why I “have the need” to act that way. Seeking attention may be the obvious observable function, but ask yourself (1) why am I needing so much attention, and (2) why am I using this behavior to get it. Don’t just “ignore” me. It doesn’t teach me anything, but makes me feel isolated and unwanted. It does not deal with why I need the attention, or teach me more appropriate ways of getting it.

When I act out when you place demands on me, yes I may be trying to “escape and avoid” these demands, so you force me to comply, so my acting out is not rewarded by allowing me to escape. You say I act out to “manipulate” you to avoid things I do not like. Have you asked yourself “why does he feel the need to escape or avoid?” If most children willfully comply, why am I resisting so adamantly. Don’t you think if I had the tools, and felt confident enough to do it successfully, that I would also “want” to do it?

When I become overwhelmed in events with overpowering sounds, sights, and smells, why would you think that forcing me through it is somehow helping me? If my brain becomes overloaded with stimulation, how can I be expected to “handle it?” What is that teaching me, if my brain doesn’t allow me to learn during those moments?

I wonder why you do not ask these questions. You call me a manipulator, lazy, disrespectful, oppositional, etc, like I somehow intentionally choose to act this way; assuming I know how to act differently. At your meeting, you sit at a table and discuss among yourselves how I must learn to act better, to not be spoiled, learn to respect others, and comply with your demands; like I am so how having “fun”, intentionally choosing to act this way. You don’t first look at what you might need to change, but try to force change on me. You scold, force, punish, and restrain me, like I purposely want to be this way. Are you that DUMB to think that if I knew how to do it right, and I felt confident doing so, I wouldn’t have more “fun” being cooperative and receiving the positive attention and rewards like all the other children. Look at my face! Look at my actions! Look at my emotions! How do you assume that this is fun!

Please let me tell you, if I felt good about myself, confident in what I am doing, and safe and accepted by you, I would not be acting this way. Either the demands of the situation are greater than I can handle, the way you are supporting (or not supporting) me is overwhelming me, or I do not feel “safe” in doing it. I do not mean to “piss you off!” I do not find joy is making you angry and lashing out at me in frustration. I am not having fun in watching everyone stare, scold, and ridicule me into submission. How do you think that timing me out, taking away privileges, and restraining me helps me to feel safe, accepted, and competent in your presence!

Please, when you look at me struggling, assume that I am feeling anxious, insecure, and most importantly “inadequate” at the moment. The stronger the opposition the more insecure and inadequate I am feeling. Then, ask yourself how can you (1) change the expectations and demands, (2) how can you provide greater assistance to support me, and (3) teach better skills for meeting these expectations. And most importantly, in the heat of a meltdown, think “how can I help him feel safe”, not “how can I control him.” And when it is over with, ask yourself how you can change the conditions next time to avoid setting me into “fight or flight”, rather than how can you punish my behavior into submission. You are the one placing me in these conditions, you are the one who has to learn to change! Yes, like for all children, I need realistic boundaries and consequences to learn to be successful, but meet me where I can realistically succeed, be a supportive mentor, and please do not assume that I am having “fun” and “prefer” to act this way!

Thanks you for listening to me. Please do it more often!

“Learning” through “relating!”

Here is one more post from "Autism Discussion Page" series. Really, I like all the posts on the page.

“Learning” through “relating!” Activate the right side brain!

Children on the spectrum have weak neurological connections between the different brain centers, rendering the processing of multiple information simultaneously, very difficult. It makes it difficult to integrate the various brain centers to maximize brain functioning. One of these integrative functions is integrating the left brain (logical, analytical, detail/factual) with the right brain (intuitive, creative, social/emotional relating). For people with autism, it is well known that they are weak in the area of social referencing, perspective taking, reading nonverbal communication, and emotion sharing; all which are important in social relating. Not only is social relating compromised, but much of our early learning is through “social learning”; learning by referencing others for information, imitating, and following the lead of others. Most early learning occurs through this relating with others. For children on the spectrum, they do not learn by taking the perspective of others, and learn by following their lead. They have to learn by individual exploration; missing out on all the “learning through others” that most child thrive on.

The recent brain research in the area of “brain plasticity”, has shown that the brain is constantly rewiring itself through experience. With each new experience, and repetition of experiences, the brain creates new neurological pathways. The brain can develop stronger neurological connections though repeated experiences that pave the way. Given this, it is important that we provide the child numerous exposure, through normal daily activities, to “experience sharing” with others, especially the primary caregiver (parents). This does not mean more rote social skills training (teaching discrete social scripts), or throwing the child into social groups and overloading them with trying to regulate with multiple peers. This is too confusing and overwhelming to them. Teaching the child “relating skills” occurs through the one on one, daily interactions with the primary caregiver (parents). These social, relating, pathways develop by but doing things together, sharing the experiences together, which sets the stage for children to (1) reference you for information, (2) sharing emotion together, (3) referencing your perspective, and (4) co-regulating, staying coordinate, in activity together. This joint attention and experience sharing with another can occur through “shared” engagement” in normal daily activities.

By “doing it together” in We-Do activities (see photo presentation on We-Do activities at Autism Discussion Page); we incorporate this essential learning into all daily activity. By “doing together” and learning through relating, we bring into play the parts of brain responsible for “relating” and develop stronger neurological pathways to those regions. We bring into play the right side of the brain, that needs further strengthening. Also, by changing from “praising” performance to “celebrating” doing it together (see three step social reward) we are developing social reciprocity (the social dance of sharing an experience). This learning through “sharing” an experience with others, provides constant exposure and activation of these neurological pathways, creating stronger social/emotional relating. While we are teaching essential life skills, by doing it together, we are also teaching social referencing, emotion sharing, and relating skills. The child is learning “through” doing with you, referencing your guidance, feeling competent learning through you. It builds stronger emotional attachment, greater relating skills, and stronger social learning skills.

So, build “relating” into your normal daily routine activities with your child, by doing them together, helping each other out, and becoming an essential element in their activity. In addition, move from praising task performance to “celebrating” doing it together, with three step social reward (physical contact, gesture, and declarative statements). By doing so, you are bringing the “social areas” of the brain into play, and developing greater neurological pathways through these experiences. For specific guidance in building these experiences and skills, please see the photo presentations on “Emotion Sharing”, “Reciprocal Interaction”, “Co-regulating interaction”, “Experience sharing” and “We-Do activity.” at Autism Discussion Page. Start developing these right brain functions by strengthening the neurological pathways in these areas.

The Challenges of Tooth brushing!

I like the Facebook page "Autism Discussion Page" and want to share it with my blog friends. I will keep posting few of them.

The Challenges of Tooth brushing!

Tooth brushing is very intrusive. When training staff we used to have them brush each other's teeth so they see could feel how intrusive it is. We don't realize that we know exactly how hard to brush, where we feel sensitivity, how to miss the gums, and how fast to brush, when we are brushing our own teeth. To have someone shove a toothbrush into your month, and brush your teeth, without you controlling it can be really discomforting. In addition, many of these children have strong sensory sensitivities. Kids that tend to be tactile defensive (touch) are often orally sensitive. There are a variety of things to try, but again, I would start by validating that you (1) recognize that brushing causes discomfort for him and (2) that it is understandable. Then from there I would try.

1. Work slowly and talk him through it, telling him what side is next.
2. It often helps to have a set number of strokes you use for each side (top, bottom, side, front, etc.). Like five back and forth strokes. Count out each stroke. Counting gives the child a definite end, allows them to judge “how much longer”, allows them to hold out a little longer, and gives them something to mentally distract them.
3. It is best to give the child as much control over the brushing as possible. Brush five strokes on one surface, then pause, and wait for child to let you know when ready for next.
4. Let the child do as much of it as they can. Even if they do poorly you can go over it.
5. Throw away your toothbrush, it may be too hard of bristles. Use a sponge toothbrush call a toothette. It is a sponge that is soft and delicate to the gums.
6. Experiment with different toothpastes to find what the child likes the best. Or, don’t use toothpaste at all. Simply use water. If you child will use a mouth rinse, this also can be added. 
7. Work slowly, and pause whenever the child shows discomfort. Continually show the child you are working with them, pausing when discomfort occurs, and letting them control the pace of brushing.
8. Many children with oral sensitivity like to use a battery operated, vibrating tooth brush. The vibration tends to dull their oral sensitivity.
9. Have fun with it. You brush his teeth, and let him brush yours...lol.
10. Reinforce the child with a strong reward once the brushing is complete.
11. Put up a chart, and let the child get a star for each time they brush. After they fill up the chart (five squares, one for each star) then they get a special reward.
12. If child doesn't like the taste of toothpaste, start off with just water, no toothpaste. Then slowly put a little on. There are liquid washes that you can substitute for those who do not like paste.
13. For some kids we actually use a soft washcloth over our finger to rub the teeth and gums, instead of a toothbrush.

When in doubt, stay supportive and try not to force. I know it takes time, but having someone force a toothbrush around your mouth can be very intrusive.