MINNEAPOLIS (CBS) ― Alex Ashkar is a model employee at the Bull Run coffee roasters. And he has autism.
"You know, its one thing to have somebody who works well, but it's also something to have someone whom you like," said Bull Run owner Greg Hoyt.
At Bull Run, Ashkar's autism is a non-issue. He typically works in the packaging department putting stickers on the boxes of coffee and taping them shut.
For Ashkar, finding meaningful work has been a lesson in understanding his limits. His first job at a local retailer didn't work out.
"They had him in a situation where he ended up working in isolation, you know, just straightening the cans, making sure that they're all facing the right way," said Alex's father Sean Ashkar.
For Alex Ashkar, a true people person, it wasn't a good match. So his family turned to Partnership Resources Incorporated, a nonprofit agency helping people with autism and other developmental disabilities find work.
With autism rates on the rise, PRI finds they are helping a lot more people who have the disorder.
"In the old days, you maybe would have out of 10, one or two. And now today, in 2008, we have eight out of 10 are on the autism spectrum, and that presents a whole different set of challenges and opportunities for us," said PRI's Dan Reed. "There's absolutely no reason they can't be extremely successful and happy in the community."
Through PRI, adults with autism or other developmental disabilities are set up with a job coach whose only job is to see that the worker succeeds. The coach devises supports that help supplement their skills, such as the counting board Alex's job coach created to keep track of how many bags of coffee go in a box.
"Alex can meander mentally a little bit, but that's part of where the job coach comes in," Reed said.
Alex and his family have had the advantage of knowing he had autism since he was only 2-years-old, but there are a lot of adults who are just now finding out they're on the spectrum.
"It explained so much. It was a relief," said Rich Cracraft, an adult with autism. "To finally have an answer to why I am the way I am."
Cracraft was diagnosed just last year. He'd suffered through countless jobs before finding success as a historical guide at the Oliver Kelly Farm in Elk River, Minn.
"It's a great mix of physical and mental," he said. "I'm not stupid. I'm a college graduate and everything like that, but my brain works slower than other people and I don't work as quickly as other people."
Cracraft sought out a diagnosis after learning his son was on the autism spectrum. He and his wife recognized a lot of common traits.
"Little things that a normal, a typical person would normally slough off are a little more sensory for him," said Lora Cracraft, Rich's wife.
Looking back, Rich Cracraft now sees symptoms that were always there.
"I can remember having a mantra of look normal, look normal, look normal, as I'm walking down the halls at school," he said.
Rich Cracraft received a diagnosis through the Autism Society of Minnesota.
"You have to be ready to accept the information the that you get," he said.
He also said he wishes there were more services for people like him, who mostly just need help understanding the social aspects of work, someone to help explain "when you walk in and there's a group of people standing there, what's the protocol for saying 'hi'."
"We have an obligation not to simply serve someone on one end of the spectrum or the other. It's an entire spectrum," said Shamus O'Meara, the head of the Governor's Council on Developmental Disabilities.
He added that a goal for the State of Minnesota is to implement more vocational services and spread the word about services that already exist. He said assembling a single resource guide for people with developmental disabilities has taken years, but there's finally a result and people with autism helped put it together through a unique digital imaging program conceived by the Governor's Council.
"I think our state is starting down an innovative road to matching technological innovation with the needs of people with disabilities," O'Meara said.
Through the digital imaging program, state and local agencies as well as private businesses are eliminating paper files.
"Technology, if used in the right way, is a great equalizer with people in the disability community," O'Meara said, adding he believes the next step is an autism task force. "I think that our state legislature needs to realize that these are families with disabilities, that there are a lot of us out there, that we're Democratic, Republican and we're not going to go away."
Saturday, July 26, 2008
Day camp lets special kids get their kicks
Summit Academy fits the bill
By Richard Price CORRESPONDENT
LEOMINSTER— As far as summer camps go, this one isn’t much to write home about to mom and dad.
There’s no archery, no lake for swimming, no campfire sing-alongs. There’s not a marshmallow to be found for roasting.
Yet parents from as far away as Andover are driving past the traditional summer camps to Leominster, where they drop off their son or daughter at a day camp in the Summit Academy School at 365 Lindell Ave.
To 7-year-old Brandon Moss, it’s the best camp in the world, even though he travels 45 minutes each way to attend. Here, he learns martial arts and loves it. For his mother, Kelly, it means a 5 a.m. wake-up and $80 a week in gas to drive round trip from Oxford.
Inside the school’s small auditorium, the class — mostly boys 7 to 10 years old — practices an age-appropriate, therapeutic version of martial arts.
They shout out the numbers 1 to 10 in Japanese while performing a series of jumping front kicks and arm-pumping thrusts.
They live with Asperger’s syndrome (an autism spectrum disorder), attention deficit disorders or other developmental disorders.
Standing on checkered floor mats, Brandon doesn’t see this as therapy to build strength, self-confidence and respect. He thinks it’s just fun.
But this modest day camp is the only one of its kind in Central Massachusetts — and only one of five in the state, according to campresource.com. Frustrated with the limited options in their communities, parents of children with learning and social disorders are willing to commute long distances every day despite the early morning wake-up time and high gas prices.
Children such as Brandon usually don’t qualify for summer programs in their towns because they are classified as highly functioning, meaning they won’t lose their skills over the summer, unlike those with severe cases of autism, said Susan Loring, director of the Autism Resource Center in West Boylston. Her state-funded center is a resource for more than 1,200 families in the area. Since these children have poorer social skills, it’s challenging for them to fit in with others at a regular day camp. Ms. Loring said the Summit camp is a welcome relief in Central Massachusetts.
Half of the children who go to the camp travel 30 minutes or more. Designed for children who struggle in a traditional public school setting, the Summit Academy is a private, year-round school with a modified program for learning and social disorders. The camp, which is in its inaugural season, costs $150 per week and runs until Aug.1. There is no financial assistance, but some school districts, Groton-Dunstable for one, have paid for six students to attend.
Daniel DiMezza, director of the Summit Academy School, said more than 40 children per week have signed up. Since building on the child’s emotional and social needs is important, the camp takes advantage of teaching moments when they happen, he said.
Jimmy Nason, 7, enrolled at Summit in April. As a first-grade student at the Hubbardston Center School, he was often overwhelmed in class and would curl up under his desk. He was diagnosed at age 3 with PDD-NOS, which is similar to Asperger’s syndrome.
Lissette Nason, Jimmy’s mother, said he is at par with other children his age academically, but socially he was evaluated way below his grade level. At times disruptive, he often spent four of his six-hour school days in the principal’s office, sent by frustrated teachers because he couldn’t grasp the imaginary elements of particular school assignments.
“He couldn’t write a story about being a bear,” Ms. Nason said. Equally frustrated with the way her son was treated, she added, “You wouldn’t penalize a child who couldn’t run a 50-yard dash.”
Since coming to Summit, Jimmy appears to be doing better. At the start of the martial arts class, he bows as he enters the room and stands on his spot on the mat, marked with a T. Wearing a blue Nike basketball outfit and skinny as a string bean, Jimmy shouts out commands with the others, “When I control my ‘T,’ I control me.”
Tammaris Mitchell is the teacher, or sensei. Referring to the program as martial arts therapy, she said the goal is to work on the whole child, not just the academic portion. Aside from developing eye-hand coordination, the program also focuses on how to identify and manage personal space and establish non-verbal communication, traits not easily learned by children like Jimmy and Brandon.
In class the students recite their creed: always to do their best, accept responsibility and show respect for others.
The lessons learned in Ms. Mitchell’s class enable the children to function for the rest of their camp day, which includes tennis, arts and crafts, and an extended school year of math, science and English.
Late in the afternoon Jimmy heads home with his mother, eager to teach his sister how to count in Japanese.
The parking lot is jammed with cars as Brandon begins his long ride home. He will rise early to attend his next martial arts class on time. This is important, according to the school handbook, because anyone can be a sensei if willing to be dedicated.
By Richard Price CORRESPONDENT
LEOMINSTER— As far as summer camps go, this one isn’t much to write home about to mom and dad.
There’s no archery, no lake for swimming, no campfire sing-alongs. There’s not a marshmallow to be found for roasting.
Yet parents from as far away as Andover are driving past the traditional summer camps to Leominster, where they drop off their son or daughter at a day camp in the Summit Academy School at 365 Lindell Ave.
To 7-year-old Brandon Moss, it’s the best camp in the world, even though he travels 45 minutes each way to attend. Here, he learns martial arts and loves it. For his mother, Kelly, it means a 5 a.m. wake-up and $80 a week in gas to drive round trip from Oxford.
Inside the school’s small auditorium, the class — mostly boys 7 to 10 years old — practices an age-appropriate, therapeutic version of martial arts.
They shout out the numbers 1 to 10 in Japanese while performing a series of jumping front kicks and arm-pumping thrusts.
They live with Asperger’s syndrome (an autism spectrum disorder), attention deficit disorders or other developmental disorders.
Standing on checkered floor mats, Brandon doesn’t see this as therapy to build strength, self-confidence and respect. He thinks it’s just fun.
But this modest day camp is the only one of its kind in Central Massachusetts — and only one of five in the state, according to campresource.com. Frustrated with the limited options in their communities, parents of children with learning and social disorders are willing to commute long distances every day despite the early morning wake-up time and high gas prices.
Children such as Brandon usually don’t qualify for summer programs in their towns because they are classified as highly functioning, meaning they won’t lose their skills over the summer, unlike those with severe cases of autism, said Susan Loring, director of the Autism Resource Center in West Boylston. Her state-funded center is a resource for more than 1,200 families in the area. Since these children have poorer social skills, it’s challenging for them to fit in with others at a regular day camp. Ms. Loring said the Summit camp is a welcome relief in Central Massachusetts.
Half of the children who go to the camp travel 30 minutes or more. Designed for children who struggle in a traditional public school setting, the Summit Academy is a private, year-round school with a modified program for learning and social disorders. The camp, which is in its inaugural season, costs $150 per week and runs until Aug.1. There is no financial assistance, but some school districts, Groton-Dunstable for one, have paid for six students to attend.
Daniel DiMezza, director of the Summit Academy School, said more than 40 children per week have signed up. Since building on the child’s emotional and social needs is important, the camp takes advantage of teaching moments when they happen, he said.
Jimmy Nason, 7, enrolled at Summit in April. As a first-grade student at the Hubbardston Center School, he was often overwhelmed in class and would curl up under his desk. He was diagnosed at age 3 with PDD-NOS, which is similar to Asperger’s syndrome.
Lissette Nason, Jimmy’s mother, said he is at par with other children his age academically, but socially he was evaluated way below his grade level. At times disruptive, he often spent four of his six-hour school days in the principal’s office, sent by frustrated teachers because he couldn’t grasp the imaginary elements of particular school assignments.
“He couldn’t write a story about being a bear,” Ms. Nason said. Equally frustrated with the way her son was treated, she added, “You wouldn’t penalize a child who couldn’t run a 50-yard dash.”
Since coming to Summit, Jimmy appears to be doing better. At the start of the martial arts class, he bows as he enters the room and stands on his spot on the mat, marked with a T. Wearing a blue Nike basketball outfit and skinny as a string bean, Jimmy shouts out commands with the others, “When I control my ‘T,’ I control me.”
Tammaris Mitchell is the teacher, or sensei. Referring to the program as martial arts therapy, she said the goal is to work on the whole child, not just the academic portion. Aside from developing eye-hand coordination, the program also focuses on how to identify and manage personal space and establish non-verbal communication, traits not easily learned by children like Jimmy and Brandon.
In class the students recite their creed: always to do their best, accept responsibility and show respect for others.
The lessons learned in Ms. Mitchell’s class enable the children to function for the rest of their camp day, which includes tennis, arts and crafts, and an extended school year of math, science and English.
Late in the afternoon Jimmy heads home with his mother, eager to teach his sister how to count in Japanese.
The parking lot is jammed with cars as Brandon begins his long ride home. He will rise early to attend his next martial arts class on time. This is important, according to the school handbook, because anyone can be a sensei if willing to be dedicated.
Autism and Athletics
By: Kathy Sweeney
For years, children with autism were often left on the sidelines, based on the belief that it would be too hard for them to handle a team sport.
But, some local boys are making a real splash in their chosen sport.
Miller Ogburn, Matthew Holman, and Danny Janisse can all be described using a single word...autism.
But, these three boys all carry another label, one they are very proud of. They're all gators, swimming on the Cape Girardeau team.
Danny Janisse, 14, loves to swim, but he's not too crazy about cameras, but he put his fears aside to talk with Heartland News.
"I've got to dive fast out there, because I pay attention good," Danny said.
While research shows autistic children benefit from staying active, the social interaction and rules of a team sport can often become too much for them to handle.
Kim Holman's son Matthew struggled in soccer, but now he's a strong swimmer with the winning ribbons to prove it.
Swim mom Kelley Pujol knows a lot about autism. She teaches music therapy at the Judevine Center for Autism in Sikeston. Kelley says this kind of repetitive activity really helps these boys from the inside out.
Danny and Matthew aren't the only winners in the pool. While they're learning each stroke, they're teaching their teammates compassion and empathy.
For years, children with autism were often left on the sidelines, based on the belief that it would be too hard for them to handle a team sport.
But, some local boys are making a real splash in their chosen sport.
Miller Ogburn, Matthew Holman, and Danny Janisse can all be described using a single word...autism.
But, these three boys all carry another label, one they are very proud of. They're all gators, swimming on the Cape Girardeau team.
Danny Janisse, 14, loves to swim, but he's not too crazy about cameras, but he put his fears aside to talk with Heartland News.
"I've got to dive fast out there, because I pay attention good," Danny said.
While research shows autistic children benefit from staying active, the social interaction and rules of a team sport can often become too much for them to handle.
Kim Holman's son Matthew struggled in soccer, but now he's a strong swimmer with the winning ribbons to prove it.
Swim mom Kelley Pujol knows a lot about autism. She teaches music therapy at the Judevine Center for Autism in Sikeston. Kelley says this kind of repetitive activity really helps these boys from the inside out.
Danny and Matthew aren't the only winners in the pool. While they're learning each stroke, they're teaching their teammates compassion and empathy.
Flying Can Be a Rough Ride for Autistic Children, Families
Parents of Autistic Children Face Special Challenges When It Comes to Travel
By REBECCA KAPLAN
USA TODAY
With heightened security regulations and frequent delays, airplane travel can be an unpleasant ordeal for anyone.
For a child who becomes anxious in close quarters, may have trouble communicating and is sensitive to loud noises, it can be terrifying.
Those are common characteristics of autism, a developmental disability that affects about one in every 150 American children and one in every 94 boys, according to data from the Centers for Disease Control and Prevention.
The condition has been getting more attention in the past five years through advocacy groups such as Autism Speaks and the Autism Society of America. But it still gets negative attention: Last week, syndicated talk radio host Michael Savage said on his show that 99 percent of the time, a child with autism was just "a brat who hasn't been told to cut the act out." The comment drew protests from the advocacy groups.
His comments probably refer to the behavior autistic children can exhibit when they feel anxious, particularly in unfamiliar situations -- they can have meltdowns that involve crying, screaming or kicking. Last month, Janice Farrell of Cary, N.C., and her 2-year-old autistic son, Jarret, were removed from their American Eagle flight after Jarret began crying and screaming uncontrollably. (The airline says Farrell also refused to stow her bag in the proper place, which she denies.)
Airline travel, which is a necessity for many families, has many characteristics that can trigger such meltdowns. In addition to the break in the normal routine -- which many autistic children find stressful because they have trouble anticipating what will happen -- airplane travel involves sitting still for long periods and being surrounded by crowds, says Rebecca Landa, director of the Center for Autism at the Kennedy Krieger Institute in Baltimore.
"Take all the issues (normal adults) have with flying, magnify that by 100, and put that into a child's body," Landa says.
James Gillespie of Philadelphia, whose 14-year-old son, Brendan, has autism, says: "You will run into any number of well-intentioned people who just look at you as if you're a bad parent. There was a time that I was pretty defensive about it."
Both Landa and Kelly Ernsperger, who counsels families in the greater Indianapolis area who are coping with autism, recommend preparing children in the days leading up to the trip by making sure they know exactly what to expect.
"I encourage families to go online and try to get pictures of the airport terminals and planes and destination," Ernsperger says. These pictures, along with conversations about what the child will be doing, help families create "social stories" so children are better able to anticipate exactly what will happen to them.
Landa also recommends letting the child make some choices -- such as choosing his seat -- to defray some of the anxiety and creating simple rules to define the social situation. Gillespie made such a rule for Brendan to let him know what topics were off-limits on airplanes: terrorists, crashing and dying.
He and other parents say snacks and earphones for a child's favorite music or movies are also a must.
It's important to let the airlines know about the situation so they can accommodate the family as well. Many airlines have taken steps to make sure that flight attendants and airport employees are trained to assist customers with disabilities.
"A lot of it is just being forthright and making sure you prepare your child, and you prepare those people who are going to come in contact with your child," says Peter Bell, executive vice president for Autism Speaks.
The public can help too, Landa says. Her No. 1 rule: Don't judge.
"It's best to think, 'How can I be helpful?' " she says, whether that is refraining from making a critical remark or offering to hold something for the family.
By REBECCA KAPLAN
USA TODAY
With heightened security regulations and frequent delays, airplane travel can be an unpleasant ordeal for anyone.
For a child who becomes anxious in close quarters, may have trouble communicating and is sensitive to loud noises, it can be terrifying.
Those are common characteristics of autism, a developmental disability that affects about one in every 150 American children and one in every 94 boys, according to data from the Centers for Disease Control and Prevention.
The condition has been getting more attention in the past five years through advocacy groups such as Autism Speaks and the Autism Society of America. But it still gets negative attention: Last week, syndicated talk radio host Michael Savage said on his show that 99 percent of the time, a child with autism was just "a brat who hasn't been told to cut the act out." The comment drew protests from the advocacy groups.
His comments probably refer to the behavior autistic children can exhibit when they feel anxious, particularly in unfamiliar situations -- they can have meltdowns that involve crying, screaming or kicking. Last month, Janice Farrell of Cary, N.C., and her 2-year-old autistic son, Jarret, were removed from their American Eagle flight after Jarret began crying and screaming uncontrollably. (The airline says Farrell also refused to stow her bag in the proper place, which she denies.)
Airline travel, which is a necessity for many families, has many characteristics that can trigger such meltdowns. In addition to the break in the normal routine -- which many autistic children find stressful because they have trouble anticipating what will happen -- airplane travel involves sitting still for long periods and being surrounded by crowds, says Rebecca Landa, director of the Center for Autism at the Kennedy Krieger Institute in Baltimore.
"Take all the issues (normal adults) have with flying, magnify that by 100, and put that into a child's body," Landa says.
James Gillespie of Philadelphia, whose 14-year-old son, Brendan, has autism, says: "You will run into any number of well-intentioned people who just look at you as if you're a bad parent. There was a time that I was pretty defensive about it."
Both Landa and Kelly Ernsperger, who counsels families in the greater Indianapolis area who are coping with autism, recommend preparing children in the days leading up to the trip by making sure they know exactly what to expect.
"I encourage families to go online and try to get pictures of the airport terminals and planes and destination," Ernsperger says. These pictures, along with conversations about what the child will be doing, help families create "social stories" so children are better able to anticipate exactly what will happen to them.
Landa also recommends letting the child make some choices -- such as choosing his seat -- to defray some of the anxiety and creating simple rules to define the social situation. Gillespie made such a rule for Brendan to let him know what topics were off-limits on airplanes: terrorists, crashing and dying.
He and other parents say snacks and earphones for a child's favorite music or movies are also a must.
It's important to let the airlines know about the situation so they can accommodate the family as well. Many airlines have taken steps to make sure that flight attendants and airport employees are trained to assist customers with disabilities.
"A lot of it is just being forthright and making sure you prepare your child, and you prepare those people who are going to come in contact with your child," says Peter Bell, executive vice president for Autism Speaks.
The public can help too, Landa says. Her No. 1 rule: Don't judge.
"It's best to think, 'How can I be helpful?' " she says, whether that is refraining from making a critical remark or offering to hold something for the family.
Thursday, May 29, 2008
Trouble-shooting specific toilet training problems
Once a visually supported transition and sequencing system has been established, we continue to use a problem-solving approach to troubleshooting details. Whenever the child has a problem with any step of the process, we think about (1) what his perspective might be and (2) how we can simplify and/or clarify through visual structure. Examples follow:
Resists sitting on the toilet
* allow to sit without removing clothes
* allow to sit with toilet covered (cardboard under the seat, gradually cutting larger hole, or towel under the seat, gradually removed)
* use potty seat on the floor rather than up high
* if strategies are helpful for sitting in other places, use in this setting also (timers, screens, picture cues, etc.)
* take turns sitting, or use doll for model
* sit together
* add physical support
* help him understand how long to sit (sing potty song, length of 1 song on tape player, set timer 1 minute, etc.)
* as he gradually begins to tolerate sitting, provide with entertainment
Afraid of flushing
* don't flush until there is something to flush
* start flush with child away from toilet, perhaps standing at the door (might mark the spot with a carpetsquare and gradually get closer to the toilet)
* give advance warning of flush, setting up flushing cue system, such as "ready, set, go"
* allow him to flush
Overly interested in flushing
* physically cover toilet handle to remove from sight
* give something else to hold and manipulate
* use visual sequence to show when to flush (after replacing clothing, for example)
* when time to flush, give child a sticker that matches to a sticker on toilet handle
Playing in water
* give him a toy with a water feature as distraction, such as a tornado tube, glitter tube, etc.
* use a padded lap desk while seated
* cover the seat until ready to use
* put a visual cue of where to stand
Playing with toilet paper
* remove it if a big problem, use Kleenex instead
* roll out amount ahead of time
* give visual cue for how much, such as putting a clothespin on where to tear, or making a tape line on the wall for where to stop
Resists being cleaned
* try different materials (wet wipes, cloth, sponge)
* consider temperature of above material
* take turns with doll
Bad aim
* supply a "target" in the water, such as a Cheerio
* larger target as toilet insert
* (contact papered or laminated cardboard with target drawn on it), gradually moved down add food coloring in the water to draw attention
Retaining when diaper is removed
* cut out bottom of diapers gradually, while allowing child to wear altered diaper to sit on the toilet
* use doll to provide visual model
* increase fluids and fiber in diet
* may need to enlist doctor if serious bowel withholding, may give stool softener
These ideas are not intended to be an inclusive list of steps to take to teach a child to use the toilet. They are, however, illustrative of the problem-solving approach needed and the effort to provide visual cues to increase understanding, cooperation, and motivation.
V. Communication System
Another important step in teaching independent toileting is to plan for a way for the child to initiate the toilet sequence. At first trips to the bathroom may be initiated by an adult directing the child to a transition object or schedule. However, eventually the child will need a way to independently communicate his need to go. Even though he may begin to spontaneously go into a familiar and available bathroom, he needs to learn a concrete way to communicate this need so that he will be able to request when a toilet is not immediately available.
As always, the first step in designing a goal is assessment. Is the child currently signaling in any way that he needs to go to the bathroom, or is he totally reliant on an adult initiating the sequence? If there are behavioral signals that you as an adult observer can "read", these signals can show you the "teachable moments" when you can help the child learn to use a systematic communication tool. Is he able to use objects, pictures, or words to communicate in other settings?
Many children first learn to use expressively the same tool that the adult has used to teach him about going to the toilet. For example, if Mom has been giving him an empty "baby-wipe" box to mean it is time to transition into the bathroom to be changed, the child might begin to use this same box to let Mom know he needs to be changed. Or, if a photograph of the toilet has been used on the child's schedule to tell him when it is time to sit on the toilet, the same photograph will make a meaningful expressive communication tool.
A child who is sometimes able to verbally say "bathroom" may not always able to pull this word up at the appropriate time. When he is tired, in a new place, with a new person, with too many people, catching a cold, upset for any reason -- his higher-level verbal skills may fail him. A child who shows this inconsistency will also be helped by a visual support that (1) helps cue the word he is looking for and (2) serves as a back-up system when he cannot use verbal language.
Resists sitting on the toilet
* allow to sit without removing clothes
* allow to sit with toilet covered (cardboard under the seat, gradually cutting larger hole, or towel under the seat, gradually removed)
* use potty seat on the floor rather than up high
* if strategies are helpful for sitting in other places, use in this setting also (timers, screens, picture cues, etc.)
* take turns sitting, or use doll for model
* sit together
* add physical support
* help him understand how long to sit (sing potty song, length of 1 song on tape player, set timer 1 minute, etc.)
* as he gradually begins to tolerate sitting, provide with entertainment
Afraid of flushing
* don't flush until there is something to flush
* start flush with child away from toilet, perhaps standing at the door (might mark the spot with a carpetsquare and gradually get closer to the toilet)
* give advance warning of flush, setting up flushing cue system, such as "ready, set, go"
* allow him to flush
Overly interested in flushing
* physically cover toilet handle to remove from sight
* give something else to hold and manipulate
* use visual sequence to show when to flush (after replacing clothing, for example)
* when time to flush, give child a sticker that matches to a sticker on toilet handle
Playing in water
* give him a toy with a water feature as distraction, such as a tornado tube, glitter tube, etc.
* use a padded lap desk while seated
* cover the seat until ready to use
* put a visual cue of where to stand
Playing with toilet paper
* remove it if a big problem, use Kleenex instead
* roll out amount ahead of time
* give visual cue for how much, such as putting a clothespin on where to tear, or making a tape line on the wall for where to stop
Resists being cleaned
* try different materials (wet wipes, cloth, sponge)
* consider temperature of above material
* take turns with doll
Bad aim
* supply a "target" in the water, such as a Cheerio
* larger target as toilet insert
* (contact papered or laminated cardboard with target drawn on it), gradually moved down add food coloring in the water to draw attention
Retaining when diaper is removed
* cut out bottom of diapers gradually, while allowing child to wear altered diaper to sit on the toilet
* use doll to provide visual model
* increase fluids and fiber in diet
* may need to enlist doctor if serious bowel withholding, may give stool softener
These ideas are not intended to be an inclusive list of steps to take to teach a child to use the toilet. They are, however, illustrative of the problem-solving approach needed and the effort to provide visual cues to increase understanding, cooperation, and motivation.
V. Communication System
Another important step in teaching independent toileting is to plan for a way for the child to initiate the toilet sequence. At first trips to the bathroom may be initiated by an adult directing the child to a transition object or schedule. However, eventually the child will need a way to independently communicate his need to go. Even though he may begin to spontaneously go into a familiar and available bathroom, he needs to learn a concrete way to communicate this need so that he will be able to request when a toilet is not immediately available.
As always, the first step in designing a goal is assessment. Is the child currently signaling in any way that he needs to go to the bathroom, or is he totally reliant on an adult initiating the sequence? If there are behavioral signals that you as an adult observer can "read", these signals can show you the "teachable moments" when you can help the child learn to use a systematic communication tool. Is he able to use objects, pictures, or words to communicate in other settings?
Many children first learn to use expressively the same tool that the adult has used to teach him about going to the toilet. For example, if Mom has been giving him an empty "baby-wipe" box to mean it is time to transition into the bathroom to be changed, the child might begin to use this same box to let Mom know he needs to be changed. Or, if a photograph of the toilet has been used on the child's schedule to tell him when it is time to sit on the toilet, the same photograph will make a meaningful expressive communication tool.
A child who is sometimes able to verbally say "bathroom" may not always able to pull this word up at the appropriate time. When he is tired, in a new place, with a new person, with too many people, catching a cold, upset for any reason -- his higher-level verbal skills may fail him. A child who shows this inconsistency will also be helped by a visual support that (1) helps cue the word he is looking for and (2) serves as a back-up system when he cannot use verbal language.
Applying Structured Teaching Principles to Toilet Training
Many children with autism are difficult to toilet train. Parents and teachers have tried many approaches to teaching the children to use the toilet independently. Not all children respond to the same teaching techniques. A method that is helpful in one child's situation may not be useful in another case. TEACCH consultants are often asked for suggestions for successful toilet training. This article is the compilation of several experienced teachers' and consultants' suggestions about this area of programming.
In thinking about setting up a program to help a child learn to toilet independently, the first TEACCH recommendation would be to try to look at the problem from the perspective of the student with autism. Another TEACCH recommendation would be to build in many elements of visual structure to help the child understand exactly what is expected. Look at each element of Structured Teaching to decide how visual supports can be added to build positive routines, clarify expectations, and reduce confrontational situations.
The child's perspective
Even in typically-developing children, toilet training is often a difficult skill to master. While the child may have good awareness and control of his body, there are other factors… social factors… that determine how easily toileting skills are learned. Small children do not feel an intrinsic desire to become toilet trained. Rather, they acquire this skill in order to please their parents and to gain the social status of " big boy" or "big girl". This social motivation is a critical factor in determining "readiness" for toilet training.
How might the characteristics of autism contribute to a child's difficulty in learning to independently use the toilet?
1. The child's difficulty with understanding and enjoying reciprocal social relationships would certainly interfere with this process. While other 2- or 3-year-olds might be proud of their "big boy pants" and might be happy to please their parents, this type of motivation is rare in a child with autism.
2. Given the characteristic difficulties in understanding language or imitating models, a child with autism may not understand what is being expected of him in the toilet.
3. A child with autism typically has significant difficulty organizing and sequencing information and with attending to relevant information consistently. Therefore following all the steps required in toileting and staying focused on what the task is all about are big challenges.
4. Further, the child's difficulty in accepting changes in his routines also makes toileting a difficult skill to master. From the child's point of view, where is the pressing need to change the familiar routine of wearing and changing a diaper? After 3, or 4, or 6 years of going in the diaper, this routine is very strongly established.
5. A child with autism may also have difficulty integrating sensory information and establishing the relationship between body sensations and everyday functional activities. Therefore he may not know how to "read" the body cues that tell him he needs to use the toilet. He may also be overly involved in the sensory stimulation of the "product"— smearing feces is not uncommon in young children with autism. The child may also be overwhelmed by the sensory environment of the toilet, with loud flushing noises, echoes, rushing water, and a chair with a big hole in it right over this water! A further consideration is that the removal of clothing for toileting may trigger exaggerated responses to the change in temperature and the tactile feeling of clothes on versus clothes off.
Elements of structured teaching
Structured Teaching is the term given to a set of teaching/support tools designed by Division TEACCH for people with autism. These tools are responsive to the characteristics of autism using their strong learning modalities (visual and motor skills and enjoyment of routine) to build bridges over some of the gaps in learning caused by their characteristic deficits. Structured Teaching not only increases the learning of new skills but also serves to increase independence and self-esteem, reducing behavior problems that result from confusion, anxiety, and over-stimulation. Structured Teaching combines the use of individualized assessment, establishment of proactive and adaptive routines, and the systematic use of visual supports to support learning.
I. Beginning step: Assessment
When hoping to toilet train a child with autism, one of the first things we must do is define a realistic goal, realizing that independent toileting may be many, many steps down the road. Each of the steps toward independent toileting is a goal itself. It is necessary to observe and assess the child's understanding of the toileting process in order to choose the correct starting point.
We should begin with establishing a positive and meaningful routine around toileting and collecting data about the child's readiness for schedule training or for independent toileting.
A simple chart can be used to collect the data needed about the child's readiness. On a routine basis, the child is taken to the bathroom for a "quick check" every 30 minutes and data is recorded on each occasion. A sample of one format for collecting this basic information is shown below.
Elimination Record
Child's Name: Date Begun:
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Time
Pants
Toilet
Pants
Toilet
Pants
Toilet
Pants
Toilet
Pants
Toilet
Pants
Toilet
Pants
Toilet
7:00
8:00
9:00
10:00
11:00
Pants column – In the column marked PANTS you will record every hour either:
D if he is dry, U if he has urinated in pants, BM if he had a bowel movement, U / BM if he had both
Of course, you don't have to wait an entire hour. Anytime you think he is wet, check him, write in the time on the chart, and record the results.
Over a period of 1 or 2 weeks, patterns of data begin to emerge.
Is the child dry for significant periods of time?
Is there some regularity in his wetting/soiling?
Does he show any indication that he is aware of being wet or soiled?
Does he pause while wetting or soiling?
A child for whom the answers to all of these questions is "no" is probably not ready for a goal of independent toileting, although a goal of establishing a positive bathroom routine may still be very appropriate.
During the charting phase, we should also be assessing other aspects of the process of toilet training. As the data is being collected,
Is the child beginning to pick up on the routine involved?
How are the child's dressing skills?
Does he show any particular fears or interests related to the bathroom (reaction to flushing, water, toilet paper roll, or other bathroom fixtures)?
What is his attention span?
At the end of this assessment period, we will have the data needed to establish an appropriate goal to be working toward.
A task analysis of the steps of toileting can give a picture of all the skills needed. Assessing the child's current skills on each step of a task analysis will help us to choose a realistic goal and remind us not to try to work on several new skills at once. Task analyses can be global or very specific. Each step of a task analysis can be further detailed to determine teaching steps. Examples of a global task analysis and a more detailed analysis of one step are illustrated below.
Task Analysis Further Task Analysis
1. Enter the bathroom (Does not do fasteners)
2. Pull clothes down
a. Allows Adult to pull
b. Pull from calves
c. Pull from knees
d. Pull from thighs
e. Pull from hips
f. Pull from waist
3. Sit on toilet
4. Get toilet tissue
5. Wipe with tissue
6. Stand up
7. Throw tissue in toilet
8. Pull clothes up
9. Flush toilet
II. Physical Structure
One of the principles of Structured Teaching involves structuring the physical environment for success. Our goal is to create a meaningful context for an activity to take place. We accomplish this through the creation of clear boundaries and the reduction of distractions.
When beginning the toilet training of a child with autism, we want to help the child learn that this set of behaviors (elimination) is associated with a particular place (the toilet). Moving all diapering, cleaning, and toileting-related dressing to this setting helps the child realize the purpose of this room. Another way to say this is that we are trying to "isolate the concept" of where toileting-related behaviors take place. Some families assign a half-bath in their homes to toilet-training, since the full bathroom has many objects that are associated with other activities and may be very distracting or confusing (bathtubs and showers, bathing toys, toothbrushes, makeup, laundry hampers, scales, etc.)
A second goal for creating clear physical structure to assist in toilet training is to create an environment that is secure and not over-stimulating. The child will be calmer and more responsive with good physical support for his body. Think about adding foot support, side rails, opening reducers, or other physical supports. Think also about the plumbing noises and echoes of many bathrooms. Many children appreciate soft music playing or the addition of sound-absorbent materials.
III. Establish a Visually Supported Routine
After establishing an appropriate goal for the child, it is important that we teach using visual supports for each step toward this goal. We must create a visual system to let the child know the step or sequence of steps to completing the goal.
At the most basic level, a transition object may be used to let the child know that the toilet routine is beginning. An object that is associated with toileting may be given to the child to serve as the transition object that takes the child to the correct location. Or, this object may be placed in a zip-lock bag that is glued shut. Or, this object may be glued to a card. In any case, it serves to initiate the bathroom routine, helping the child know what is to occur and where. At a more abstract level, a photograph or drawing of the toilet or the printed word on a card may given to the child or placed on his schedule to accomplish this goal.
Once the transition to the toilet area has been made, it is important to continue to visually support each step of the toileting routine. We need to let the child know each step he is to accomplish, when the sequence will be finished, and what will happen when the sequence is finished. Again, using an object sequence, a picture sequence, or a written list are all ways to communicate this information to the child. It is important that the child sees the information, manipulates the system so that he recognizes it's connection to his behavior, and has a clear way to recognize when each step – and the entire process – is finished.
The inclusion of a concrete, visual "what happens when I'm finished" piece of information is an important part of this system. For some children this may be looked at as a motivator or even a reward. For many children with autism, it is equally or more important as a clear indication of closure. Task completion is a powerful motivator for most people with autism.
In thinking about setting up a program to help a child learn to toilet independently, the first TEACCH recommendation would be to try to look at the problem from the perspective of the student with autism. Another TEACCH recommendation would be to build in many elements of visual structure to help the child understand exactly what is expected. Look at each element of Structured Teaching to decide how visual supports can be added to build positive routines, clarify expectations, and reduce confrontational situations.
The child's perspective
Even in typically-developing children, toilet training is often a difficult skill to master. While the child may have good awareness and control of his body, there are other factors… social factors… that determine how easily toileting skills are learned. Small children do not feel an intrinsic desire to become toilet trained. Rather, they acquire this skill in order to please their parents and to gain the social status of " big boy" or "big girl". This social motivation is a critical factor in determining "readiness" for toilet training.
How might the characteristics of autism contribute to a child's difficulty in learning to independently use the toilet?
1. The child's difficulty with understanding and enjoying reciprocal social relationships would certainly interfere with this process. While other 2- or 3-year-olds might be proud of their "big boy pants" and might be happy to please their parents, this type of motivation is rare in a child with autism.
2. Given the characteristic difficulties in understanding language or imitating models, a child with autism may not understand what is being expected of him in the toilet.
3. A child with autism typically has significant difficulty organizing and sequencing information and with attending to relevant information consistently. Therefore following all the steps required in toileting and staying focused on what the task is all about are big challenges.
4. Further, the child's difficulty in accepting changes in his routines also makes toileting a difficult skill to master. From the child's point of view, where is the pressing need to change the familiar routine of wearing and changing a diaper? After 3, or 4, or 6 years of going in the diaper, this routine is very strongly established.
5. A child with autism may also have difficulty integrating sensory information and establishing the relationship between body sensations and everyday functional activities. Therefore he may not know how to "read" the body cues that tell him he needs to use the toilet. He may also be overly involved in the sensory stimulation of the "product"— smearing feces is not uncommon in young children with autism. The child may also be overwhelmed by the sensory environment of the toilet, with loud flushing noises, echoes, rushing water, and a chair with a big hole in it right over this water! A further consideration is that the removal of clothing for toileting may trigger exaggerated responses to the change in temperature and the tactile feeling of clothes on versus clothes off.
Elements of structured teaching
Structured Teaching is the term given to a set of teaching/support tools designed by Division TEACCH for people with autism. These tools are responsive to the characteristics of autism using their strong learning modalities (visual and motor skills and enjoyment of routine) to build bridges over some of the gaps in learning caused by their characteristic deficits. Structured Teaching not only increases the learning of new skills but also serves to increase independence and self-esteem, reducing behavior problems that result from confusion, anxiety, and over-stimulation. Structured Teaching combines the use of individualized assessment, establishment of proactive and adaptive routines, and the systematic use of visual supports to support learning.
I. Beginning step: Assessment
When hoping to toilet train a child with autism, one of the first things we must do is define a realistic goal, realizing that independent toileting may be many, many steps down the road. Each of the steps toward independent toileting is a goal itself. It is necessary to observe and assess the child's understanding of the toileting process in order to choose the correct starting point.
We should begin with establishing a positive and meaningful routine around toileting and collecting data about the child's readiness for schedule training or for independent toileting.
A simple chart can be used to collect the data needed about the child's readiness. On a routine basis, the child is taken to the bathroom for a "quick check" every 30 minutes and data is recorded on each occasion. A sample of one format for collecting this basic information is shown below.
Elimination Record
Child's Name: Date Begun:
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7
Time
Pants
Toilet
Pants
Toilet
Pants
Toilet
Pants
Toilet
Pants
Toilet
Pants
Toilet
Pants
Toilet
7:00
8:00
9:00
10:00
11:00
Pants column – In the column marked PANTS you will record every hour either:
D if he is dry, U if he has urinated in pants, BM if he had a bowel movement, U / BM if he had both
Of course, you don't have to wait an entire hour. Anytime you think he is wet, check him, write in the time on the chart, and record the results.
Over a period of 1 or 2 weeks, patterns of data begin to emerge.
Is the child dry for significant periods of time?
Is there some regularity in his wetting/soiling?
Does he show any indication that he is aware of being wet or soiled?
Does he pause while wetting or soiling?
A child for whom the answers to all of these questions is "no" is probably not ready for a goal of independent toileting, although a goal of establishing a positive bathroom routine may still be very appropriate.
During the charting phase, we should also be assessing other aspects of the process of toilet training. As the data is being collected,
Is the child beginning to pick up on the routine involved?
How are the child's dressing skills?
Does he show any particular fears or interests related to the bathroom (reaction to flushing, water, toilet paper roll, or other bathroom fixtures)?
What is his attention span?
At the end of this assessment period, we will have the data needed to establish an appropriate goal to be working toward.
A task analysis of the steps of toileting can give a picture of all the skills needed. Assessing the child's current skills on each step of a task analysis will help us to choose a realistic goal and remind us not to try to work on several new skills at once. Task analyses can be global or very specific. Each step of a task analysis can be further detailed to determine teaching steps. Examples of a global task analysis and a more detailed analysis of one step are illustrated below.
Task Analysis Further Task Analysis
1. Enter the bathroom (Does not do fasteners)
2. Pull clothes down
a. Allows Adult to pull
b. Pull from calves
c. Pull from knees
d. Pull from thighs
e. Pull from hips
f. Pull from waist
3. Sit on toilet
4. Get toilet tissue
5. Wipe with tissue
6. Stand up
7. Throw tissue in toilet
8. Pull clothes up
9. Flush toilet
II. Physical Structure
One of the principles of Structured Teaching involves structuring the physical environment for success. Our goal is to create a meaningful context for an activity to take place. We accomplish this through the creation of clear boundaries and the reduction of distractions.
When beginning the toilet training of a child with autism, we want to help the child learn that this set of behaviors (elimination) is associated with a particular place (the toilet). Moving all diapering, cleaning, and toileting-related dressing to this setting helps the child realize the purpose of this room. Another way to say this is that we are trying to "isolate the concept" of where toileting-related behaviors take place. Some families assign a half-bath in their homes to toilet-training, since the full bathroom has many objects that are associated with other activities and may be very distracting or confusing (bathtubs and showers, bathing toys, toothbrushes, makeup, laundry hampers, scales, etc.)
A second goal for creating clear physical structure to assist in toilet training is to create an environment that is secure and not over-stimulating. The child will be calmer and more responsive with good physical support for his body. Think about adding foot support, side rails, opening reducers, or other physical supports. Think also about the plumbing noises and echoes of many bathrooms. Many children appreciate soft music playing or the addition of sound-absorbent materials.
III. Establish a Visually Supported Routine
After establishing an appropriate goal for the child, it is important that we teach using visual supports for each step toward this goal. We must create a visual system to let the child know the step or sequence of steps to completing the goal.
At the most basic level, a transition object may be used to let the child know that the toilet routine is beginning. An object that is associated with toileting may be given to the child to serve as the transition object that takes the child to the correct location. Or, this object may be placed in a zip-lock bag that is glued shut. Or, this object may be glued to a card. In any case, it serves to initiate the bathroom routine, helping the child know what is to occur and where. At a more abstract level, a photograph or drawing of the toilet or the printed word on a card may given to the child or placed on his schedule to accomplish this goal.
Once the transition to the toilet area has been made, it is important to continue to visually support each step of the toileting routine. We need to let the child know each step he is to accomplish, when the sequence will be finished, and what will happen when the sequence is finished. Again, using an object sequence, a picture sequence, or a written list are all ways to communicate this information to the child. It is important that the child sees the information, manipulates the system so that he recognizes it's connection to his behavior, and has a clear way to recognize when each step – and the entire process – is finished.
The inclusion of a concrete, visual "what happens when I'm finished" piece of information is an important part of this system. For some children this may be looked at as a motivator or even a reward. For many children with autism, it is equally or more important as a clear indication of closure. Task completion is a powerful motivator for most people with autism.
Sunday, May 4, 2008
Visual Thinking Teaching Suggestions
Teaching Suggestions
Replace the learned helplessness of "waiting for ideas to happen" with learned confidence. That confidence will be based on successful practice and achievement through disciplined visual thinking.
Teach students to let ideas evolve out of the practice of ongoing visual thinking rather than being determined by verbal reasoning.
Focus as an instructor on "scaffold thinking" even though the student may be deeply involved with verbal explanations of personal meaning.
Teach and personally value observational speed (quickness) in capturing visual events.
Insist that all mental events must be given some form in the exterior world of materials before they are considered valid visual thoughts.
Stress looking for the 2nd, 3rd, and 4th "right" answers to every problem.
In order to pose the right hemisphere new challenges for synthesis, shift:
-The focus of attention
-The sequence of input
Make all activities and exercises specific to one thought process at a time in order to attain the maximum in learning efficiency
Attention exercises should teach that attention is undivided, follows interest, is dynamic, and is a constant process of discovery.
Replace the learned helplessness of "waiting for ideas to happen" with learned confidence. That confidence will be based on successful practice and achievement through disciplined visual thinking.
Teach students to let ideas evolve out of the practice of ongoing visual thinking rather than being determined by verbal reasoning.
Focus as an instructor on "scaffold thinking" even though the student may be deeply involved with verbal explanations of personal meaning.
Teach and personally value observational speed (quickness) in capturing visual events.
Insist that all mental events must be given some form in the exterior world of materials before they are considered valid visual thoughts.
Stress looking for the 2nd, 3rd, and 4th "right" answers to every problem.
In order to pose the right hemisphere new challenges for synthesis, shift:
-The focus of attention
-The sequence of input
Make all activities and exercises specific to one thought process at a time in order to attain the maximum in learning efficiency
Attention exercises should teach that attention is undivided, follows interest, is dynamic, and is a constant process of discovery.
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