P.L.A.Y. Project Research

I love the P.L.A.Y. Project (Play and Language for Autistic Youngsters). I love being able to coach parents as they connect with their children through play, and help their children progress developmentally. It's so exciting to see the progress of the kids, and to see how empowering this program is for parents. I really do love it.

In October 2014, P.L.A.Y. Project research was published in the Journal of Developmental & Behavioral Pediatrics. Please check it out, it's exciting, as the P.L.A.Y. Project has been working on this research for the past few years.

Through the P.L.A.Y. Project (www.playproject.org), they found significant improvements in:

• caregiver/parent and child interaction
• social interaction of children with autism
• social-emotional development of children with autism
• autism symptomatology

Secondary outcomes included:

• improved parent stress and depression
• P.L.A.Y. Project consultant fidelity

I love the P.L.A.Y. Project (Play and Language for Autistic Youngsters). I love being able to coach parents as they connect with their children through play, and help their children progress developmentally. It's so exciting to see the progress of the kids, and to see how empowering this program is for parents. I really do love it.

In October 2014, P.L.A.Y. Project research was published in the Journal of Developmental & Behavioral Pediatrics. Please check it out, it's exciting, as the P.L.A.Y. Project has been working on this research for the past few years.

Through the P.L.A.Y. Project (www.playproject.org), they found significant improvements in:

• caregiver/parent and child interaction
• social interaction of children with autism
• social-emotional development of children with autism
• autism symptomatology

Secondary outcomes included:

• improved parent stress and depression
• P.L.A.Y. Project consultant fidelity

Wait Time

When a child has language delays, oftentimes their processing time is longer than we actually give them. We may say something like "get your coat on" and then when they don't immediately respond, we say "put your jacket on." Then when they still just look at us blankly we say "why aren't you doing what I asked?"

We think that we're giving them plenty of time to respond, but we're not. I've always had a goal to learn Spanish, and I know enough to get by, but not enough to have a conversation. I usually say I can speak like a 3-year-old. I can speak in 3-5 word sentences pretty well. When I have been traveling and people are talking to me (usually much faster than I can process) sometimes I look at them blankly as I try to figure out what they just said. Then just as I'm about to figure it out, they say rephrase what they just told me. So now, not only am I trying to figure out what they said initially, now I have to figure out a new sentence (which actually means the same thing as the first sentence, but I don't always know that). And so it slows me down even more. By the third sentence, I just kind of give up and say "I don't understand."

I honk this can relate to some of the kids we work with. We need to check ourselves to see if we are givng them enough time to process what we've said before we assume they're not listening. Counting to ten may feel like forever, but it may also give enough time for a response rather than prompting a response. Repeating instructions verbatim may also be helpful for kids who take a longer time deciding what you said the first time. 

Sometimes one of our greatest tools can just be our wait time. We don't always have to be in such a hurry :)

When a child has language delays, oftentimes their processing time is longer than we actually give them. We may say something like "get your coat on" and then when they don't immediately respond, we say "put your jacket on." Then when they still just look at us blankly we say "why aren't you doing what I asked?"

We think that we're giving them plenty of time to respond, but we're not. I've always had a goal to learn Spanish, and I know enough to get by, but not enough to have a conversation. I usually say I can speak like a 3-year-old. I can speak in 3-5 word sentences pretty well. When I have been traveling and people are talking to me (usually much faster than I can process) sometimes I look at them blankly as I try to figure out what they just said. Then just as I'm about to figure it out, they say rephrase what they just told me. So now, not only am I trying to figure out what they said initially, now I have to figure out a new sentence (which actually means the same thing as the first sentence, but I don't always know that). And so it slows me down even more. By the third sentence, I just kind of give up and say "I don't understand."

I honk this can relate to some of the kids we work with. We need to check ourselves to see if we are givng them enough time to process what we've said before we assume they're not listening. Counting to ten may feel like forever, but it may also give enough time for a response rather than prompting a response. Repeating instructions verbatim may also be helpful for kids who take a longer time deciding what you said the first time. 

Sometimes one of our greatest tools can just be our wait time. We don't always have to be in such a hurry :)

More senses than 5

Before I started working with kids with autism, I had heard quite a bit about sensory input. My sister is a pediatric occupational therapist and works a lot with sensory integration. Then when I started working in the school setting, I had one of the best occupational therapists working with my students. I have been privileged to be in the midst of some great occupational therapists throughout my career.

We always hear about the 5 senses, and then we hear about the 6th sense. Well, there is really a 6th sense and a 7th and probably more. The way we experience the world we live in is quite incredible, I have to say. There is so much to process, and our bodies are capable of so much.

I just want to give a quick overview of three of our senses: tactile, vestibular, and proprioceptive.  Some kids may be seekers, and others may be avoiders. And a kid can be a seeker in one area and an avoider in another. We are all different, and so we individualize our approach :)

TACTILE: This is how we take in information through our skin, we process information about touch with this sense. This has to do with lighter touch. Different textures may have different reactions. Some textures you may want to think about are soft, hard, slimy, wet, gooey, crunchy, fuzzy, etc.

VESTIBULAR: This is how we receive information through our inner ear. It has to do with movement, gravity, and balance. Some activities you may look at to see if your child avoids or seeks might be swinging, spinning, running, climbing, rocking, bouncing, etc.

PROPRIOCEPTIVE: This is how we take in information through our muscles, ligaments, and joints. We process information about body position and body parts. Activities might include wrestling, tickling, being buried in pillows, crashing into things, pushing heavy things, etc.

As we are more aware of a child's sensory motor profile, we can facilitate activities in these areas to promote greater engagement and help in the child's development.

If you're interested, here's another post I did a while back about our sensory systems: http://www.playwithjoy.com/2013/01/our-sensory-systems-and-learning.html

Before I started working with kids with autism, I had heard quite a bit about sensory input. My sister is a pediatric occupational therapist and works a lot with sensory integration. Then when I started working in the school setting, I had one of the best occupational therapists working with my students. I have been privileged to be in the midst of some great occupational therapists throughout my career.

We always hear about the 5 senses, and then we hear about the 6th sense. Well, there is really a 6th sense and a 7th and probably more. The way we experience the world we live in is quite incredible, I have to say. There is so much to process, and our bodies are capable of so much.

I just want to give a quick overview of three of our senses: tactile, vestibular, and proprioceptive.  Some kids may be seekers, and others may be avoiders. And a kid can be a seeker in one area and an avoider in another. We are all different, and so we individualize our approach :)

TACTILE: This is how we take in information through our skin, we process information about touch with this sense. This has to do with lighter touch. Different textures may have different reactions. Some textures you may want to think about are soft, hard, slimy, wet, gooey, crunchy, fuzzy, etc.

VESTIBULAR: This is how we receive information through our inner ear. It has to do with movement, gravity, and balance. Some activities you may look at to see if your child avoids or seeks might be swinging, spinning, running, climbing, rocking, bouncing, etc.

PROPRIOCEPTIVE: This is how we take in information through our muscles, ligaments, and joints. We process information about body position and body parts. Activities might include wrestling, tickling, being buried in pillows, crashing into things, pushing heavy things, etc.

As we are more aware of a child's sensory motor profile, we can facilitate activities in these areas to promote greater engagement and help in the child's development.

If you're interested, here's another post I did a while back about our sensory systems: http://www.playwithjoy.com/2013/01/our-sensory-systems-and-learning.html

Safety

I recently did a training for the staff I work with about Maslow's Hierarchy of Needs. It got me thinking a lot about the second level of the pyramid, which is safety. In order to continue up the pyramid to relationships, achievement, and self-actialization there is this need to feel and be safe.

If that safety is missing, it can be so hard to reach our potential because we fall into survival mode and oftentimes react in a way that might be defensive rather than moving forward towards our potential. We are just trying not to go backwards because of fear rather than confidently moving towards our goals and dreams.

I've been there, and it wasn't a very happy place for me. So how does this relate to the kiddos that we work with? Everything. It's important that we create an environment that is not only physically safe, but also emotionally safe. A place where it's ok to fall because you know that someone will be there to encourage you and cheer you on to keep going.

Temple Grandin is an incredible woman, who has helped the world understand autism on a different level. She is a scholar and a woman of success, and she knows what it's like first hand to have autism. At one conference I attended, she talked about how her amygdala (fear center) is four times larger than the average person. This has stuck out to me since I heard her say that. So building an environment of safety takes on even greater meaning. Being safe is one thing, but feeling safe can be on a completely different level.

Just a few things we can do to help kids feel safe is to build a routine that is predictable. Picture schedules can be a great way to communicate the schedule. Priming can help prepare for upcoming transitions. Having boundaries is really important. When the boundaries keep changing, it can be difficult for a child to be able predict what is going to happen. Being aware of sensory overload and how to cope with that is also important when considering the environment. There are so many things to consider, more than I am going to write in this post. Little by little you can get there, don't feel overwhelmed with all you feel needs to be done. Just take it one step at a time. Little by little as the child progresses, less supports will be required as you see them move through different stages.

I recently did a training for the staff I work with about Maslow's Hierarchy of Needs. It got me thinking a lot about the second level of the pyramid, which is safety. In order to continue up the pyramid to relationships, achievement, and self-actialization there is this need to feel and be safe.

If that safety is missing, it can be so hard to reach our potential because we fall into survival mode and oftentimes react in a way that might be defensive rather than moving forward towards our potential. We are just trying not to go backwards because of fear rather than confidently moving towards our goals and dreams.

I've been there, and it wasn't a very happy place for me. So how does this relate to the kiddos that we work with? Everything. It's important that we create an environment that is not only physically safe, but also emotionally safe. A place where it's ok to fall because you know that someone will be there to encourage you and cheer you on to keep going.

Temple Grandin is an incredible woman, who has helped the world understand autism on a different level. She is a scholar and a woman of success, and she knows what it's like first hand to have autism. At one conference I attended, she talked about how her amygdala (fear center) is four times larger than the average person. This has stuck out to me since I heard her say that. So building an environment of safety takes on even greater meaning. Being safe is one thing, but feeling safe can be on a completely different level.

Just a few things we can do to help kids feel safe is to build a routine that is predictable. Picture schedules can be a great way to communicate the schedule. Priming can help prepare for upcoming transitions. Having boundaries is really important. When the boundaries keep changing, it can be difficult for a child to be able predict what is going to happen. Being aware of sensory overload and how to cope with that is also important when considering the environment. There are so many things to consider, more than I am going to write in this post. Little by little you can get there, don't feel overwhelmed with all you feel needs to be done. Just take it one step at a time. Little by little as the child progresses, less supports will be required as you see them move through different stages.

Positive Reinforcement vs. Negative Reinforcement

In general, I think there are a lot of misconceptions about what negative reinforcement is. Before I started studying behavior, I just figured negative reinforcement was giving negative consequences when a child did something inappropriate. Well, I was wrong.

I'm just going to go over some definitions to clear things up a bit, and then I'll post another day about examples of different types of reinforcement.

What is reinforcement? Something is being reinforced when the behavior increases. For example if we want a child to put away his backpack every day after school, we want to reinforce that behavior so that the probability of it happening will increase.

So the result of reinforcement is the same (an increase or maintenance in behavior) whether it's positive or negative. Let's look at what positive and negative are referring to.

Positive (+) = adding something
Negative (-) = taking something away

Positive Reinforcement = adding something to increase or maintain the rate of the behavior
Negative Reinforcement = taking something away to increase or maintain the rate of the behavior

Example: A child is asked to finish his dinner. The positive reinforcement is that he can go play as soon as he's done (being able to play is added). The negative reinforcement is that the parent nagging the child to finish eating will stop (the nagging is taken away).

Sometimes it can be difficult to discriminate between these two types of reinforcement, and in some cases it may not really matter, but overall I feel like it's important to have a brief idea of the differences when having discussions about behavior, or reading literature about it. Hope this is helpful.

In general, I think there are a lot of misconceptions about what negative reinforcement is. Before I started studying behavior, I just figured negative reinforcement was giving negative consequences when a child did something inappropriate. Well, I was wrong.

I'm just going to go over some definitions to clear things up a bit, and then I'll post another day about examples of different types of reinforcement.

What is reinforcement? Something is being reinforced when the behavior increases. For example if we want a child to put away his backpack every day after school, we want to reinforce that behavior so that the probability of it happening will increase.

So the result of reinforcement is the same (an increase or maintenance in behavior) whether it's positive or negative. Let's look at what positive and negative are referring to.

Positive (+) = adding something
Negative (-) = taking something away

Positive Reinforcement = adding something to increase or maintain the rate of the behavior
Negative Reinforcement = taking something away to increase or maintain the rate of the behavior

Example: A child is asked to finish his dinner. The positive reinforcement is that he can go play as soon as he's done (being able to play is added). The negative reinforcement is that the parent nagging the child to finish eating will stop (the nagging is taken away).

Sometimes it can be difficult to discriminate between these two types of reinforcement, and in some cases it may not really matter, but overall I feel like it's important to have a brief idea of the differences when having discussions about behavior, or reading literature about it. Hope this is helpful.

Safety Day & Trunk or Treat in Ogden, Utah

This is a great activity set for this week! A great activity for the whole family!

This is a great activity set for this week! A great activity for the whole family!

Circles of Communication

What is a circle of communication? The first half of the circle is an initiation (someone knocks on the door) and the second half is the response (someone else opens the door). There are all different sizes of circles. Some are big and obvious, and some are more subtle and sometimes we miss them if we're not paying close attention. A big circle might be calling someone's name and them turning around and saying "what?" A smaller circle might be when you're playing chase and your child glances back at you to see if you're still coming. A really subtle circle might be when you glance at your child and you see them briefly look back at you.

Circles can be really hard to count at times, but the important thing is this back and forth interaction. As we look at our world around us, it is all about these back and forth interactions with others. Relationships are based on these back and forth interactions. With some kids, this may be a difficult thing to master. They may not see a purpose in it, they may not find enjoyment in it, or they may just not know how to do it.

Dr. Stanley Greenspan introduces the functional developmental levels through DIR/Floortime. Circles of communication begin at functional developmental level 3. As we work with kids to help them progress through the functional developmental levels, it is important that we are aware of how many circles of communication they are getting. We use simple techniques to encourage more circles of communication. As the child increases the number of circles of communication they are having, we also bump them up to a higher functional developmental level.

These circles do not have to be verbal circles, a kid who does not talk yet can get hundreds of back and forth circles without saying a word. How do we do it? We do it through PLAY. It is important that as children learn to increase their circles of communication that we are giving them opportunities to express themselves on their own. We can tell a kid what to do every step of the way, but how much more rich and motivating would it be if the child is giving us cues of what they want instead. We need to follow their lead.

One of the many techniques that you can use is called 'playful obstruction.'  In many ways, that just means playing dumb. We're all good at that, even when we don't mean to be, right? Instead of doing all the mind reading that we tend to do, play dumb. Make the child open a few more circles to get what they want. Give them the wrong thing, say the wrong thing, make them expand, make them work. Just by playing dumb, you can extend the interaction. If it's really really motivating, then expect even more. Be aware of where that breaking point is, and take them to the limits. If you lose them, that's ok, then you know that next time you'll pull back a little sooner.

Having these circles of communication is really important, and is a pre-requisite to having conversations, or engaging in higher levels of play. Try to count how many consecutive circles your child has a time, and try to expand on that. If there's so many it's hard to count, great! Instead of working on the quantity of cirlces, start to work on the quality.

What is a circle of communication? The first half of the circle is an initiation (someone knocks on the door) and the second half is the response (someone else opens the door). There are all different sizes of circles. Some are big and obvious, and some are more subtle and sometimes we miss them if we're not paying close attention. A big circle might be calling someone's name and them turning around and saying "what?" A smaller circle might be when you're playing chase and your child glances back at you to see if you're still coming. A really subtle circle might be when you glance at your child and you see them briefly look back at you.

Circles can be really hard to count at times, but the important thing is this back and forth interaction. As we look at our world around us, it is all about these back and forth interactions with others. Relationships are based on these back and forth interactions. With some kids, this may be a difficult thing to master. They may not see a purpose in it, they may not find enjoyment in it, or they may just not know how to do it.

Dr. Stanley Greenspan introduces the functional developmental levels through DIR/Floortime. Circles of communication begin at functional developmental level 3. As we work with kids to help them progress through the functional developmental levels, it is important that we are aware of how many circles of communication they are getting. We use simple techniques to encourage more circles of communication. As the child increases the number of circles of communication they are having, we also bump them up to a higher functional developmental level.

These circles do not have to be verbal circles, a kid who does not talk yet can get hundreds of back and forth circles without saying a word. How do we do it? We do it through PLAY. It is important that as children learn to increase their circles of communication that we are giving them opportunities to express themselves on their own. We can tell a kid what to do every step of the way, but how much more rich and motivating would it be if the child is giving us cues of what they want instead. We need to follow their lead.

One of the many techniques that you can use is called 'playful obstruction.'  In many ways, that just means playing dumb. We're all good at that, even when we don't mean to be, right? Instead of doing all the mind reading that we tend to do, play dumb. Make the child open a few more circles to get what they want. Give them the wrong thing, say the wrong thing, make them expand, make them work. Just by playing dumb, you can extend the interaction. If it's really really motivating, then expect even more. Be aware of where that breaking point is, and take them to the limits. If you lose them, that's ok, then you know that next time you'll pull back a little sooner.

Having these circles of communication is really important, and is a pre-requisite to having conversations, or engaging in higher levels of play. Try to count how many consecutive circles your child has a time, and try to expand on that. If there's so many it's hard to count, great! Instead of working on the quantity of cirlces, start to work on the quality.

Greetings!

It's been a while since I've blogged, but I have made it a goal to get back into it.

Today I want to talk about greetings. Last year I had this student who had the ability to say hello, but just never did it. Every day I would say hello to him and every day he would just look at me blankly or he would just ignore me and look away. Sometimes I would prompt him to say hello to me, but he still never did it. Sometimes I would get really dramatic and say "WHY WON'T YOU SAY HI TO ME??!!??" and he would just laugh and think I was silly.

These past few weeks I have returned to his classroom to work with him on greetings for one of my school projects (yes, I decided to go back to school once again...learnings good, right?). So after a year of trying to get him to say hello to me, I wasn't expecting this to be extremely easy, but guess what...it was. Part of it was probably maturity, but part of it was also technique. I'm not saying that it's going to be easy with any kid you work with, it just happened to be easy this time.

The general prompting in the natural environment didn't work, we saw that, so I decided to combine a few techniques. I'm sharing this in hopes that it may give you some ideas of what you can do, not just for greeting but maybe for some other goals you might be working on. Some of you may read this and think, duh why didn't you do that in the first place, and I'm ok with that.  That's really what I was thinking once I started doing it.

First, baseline data was 0% for 3 consecutive days. He did not respond to one greeting he was given. The definition of greeting in this instance is responding to a greeting by saying "hello", "hi", or waving one hand towards the person being greeted.  After baseline was taken, here's what I did.

TELL PROCEDURE
In a one on one setting I said something like “when someone says “hello” or “hi” to you, they are being nice and would like you to respond back to them.  You can say “hello”, “hi”, or you can wave your hand in their direction.  If you know their name, you can say “hello” and then say their name. If you don’t know their name, or you don’t remember their name, it’s ok to just say “hello”, “hi”, or wave back to them.”
 Why did I not think of this before? What may seem obvious to us is not always obvious to kids struggling with autism. So this technique of explaining things actually has an official title, it's called the Tell Procedure. You simply state the rules.

VIDEO MODELING
Next we used some video modeling. I don't know that it was true video modeling because the people in my videos were just saying hi to the kid (we'll call him Junior). I had filmed about 10 people before I met with him and they all said "Hi, Junior." Easy to do with an iPad. So they modeled how to greet him, but I also used it as the antecedent to the target behavior (greeting). So we practiced. First I would ask if he knew that person while it was on a screenshot of them, if he did then I would model some things he could say. For example if it was me on the screen, he could say "Hi, Joy" or "Hello, Joy." Then we would press play, the person would say "Hi, Junior." and Junior would say "Hi" back. Pretty simple. Luckily he was compliant and was having fun with seeing who would be next on the screen.

POSITIVE REINFORCEMENT
We used some positive reinforcement giving a lot of praise and showing a lot of excitement every time he did it correctly. The nice thing about a goal like this is that there's a lot of natural positive reinforcement...when you say "hi" to people, they generally will smile or get excited to start talking to you (especially if you've never said hi to them before and now you are).

NATURAL ENVIRONMENT
After going through all the videos, we went into the hallway to practice. Luckily the staff were all great and would naturally say hello to Junior, and even some peers did as well. Being in the natural environment and interacting with a variety of people will help with generalization skills.  The progress that Junior made in those 10-15 minutes were pretty great.  Junior went from a 0% response to 60%, and continued averaging about a 70% response rate over the next 3 sessions.

MINIMUM-TO-MAXIMUM PROMPTING
While we would practice in the natural environment, I used a minimum-to-maximum prompting procedure. I would allow Junior to first respond independently, if he didn't respond then I would give a verbal prompt (i.e., "She just said hello, what do you say?"), if that didn't work then I would give a model (i.e., "Say hi"), then if that didn't work then I would give a physical prompt to wave his hand. He only ever ended up needing a verbal prompt (which never worked last year).

There are a lot of different techniques out there, sometimes it can work to your benefit to find ones that can be used effectively together, and you may have greater success.

It's been a while since I've blogged, but I have made it a goal to get back into it.

Today I want to talk about greetings. Last year I had this student who had the ability to say hello, but just never did it. Every day I would say hello to him and every day he would just look at me blankly or he would just ignore me and look away. Sometimes I would prompt him to say hello to me, but he still never did it. Sometimes I would get really dramatic and say "WHY WON'T YOU SAY HI TO ME??!!??" and he would just laugh and think I was silly.

These past few weeks I have returned to his classroom to work with him on greetings for one of my school projects (yes, I decided to go back to school once again...learnings good, right?). So after a year of trying to get him to say hello to me, I wasn't expecting this to be extremely easy, but guess what...it was. Part of it was probably maturity, but part of it was also technique. I'm not saying that it's going to be easy with any kid you work with, it just happened to be easy this time.

The general prompting in the natural environment didn't work, we saw that, so I decided to combine a few techniques. I'm sharing this in hopes that it may give you some ideas of what you can do, not just for greeting but maybe for some other goals you might be working on. Some of you may read this and think, duh why didn't you do that in the first place, and I'm ok with that.  That's really what I was thinking once I started doing it.

First, baseline data was 0% for 3 consecutive days. He did not respond to one greeting he was given. The definition of greeting in this instance is responding to a greeting by saying "hello", "hi", or waving one hand towards the person being greeted.  After baseline was taken, here's what I did.

TELL PROCEDURE
In a one on one setting I said something like “when someone says “hello” or “hi” to you, they are being nice and would like you to respond back to them.  You can say “hello”, “hi”, or you can wave your hand in their direction.  If you know their name, you can say “hello” and then say their name. If you don’t know their name, or you don’t remember their name, it’s ok to just say “hello”, “hi”, or wave back to them.”
 Why did I not think of this before? What may seem obvious to us is not always obvious to kids struggling with autism. So this technique of explaining things actually has an official title, it's called the Tell Procedure. You simply state the rules.

VIDEO MODELING
Next we used some video modeling. I don't know that it was true video modeling because the people in my videos were just saying hi to the kid (we'll call him Junior). I had filmed about 10 people before I met with him and they all said "Hi, Junior." Easy to do with an iPad. So they modeled how to greet him, but I also used it as the antecedent to the target behavior (greeting). So we practiced. First I would ask if he knew that person while it was on a screenshot of them, if he did then I would model some things he could say. For example if it was me on the screen, he could say "Hi, Joy" or "Hello, Joy." Then we would press play, the person would say "Hi, Junior." and Junior would say "Hi" back. Pretty simple. Luckily he was compliant and was having fun with seeing who would be next on the screen.

POSITIVE REINFORCEMENT
We used some positive reinforcement giving a lot of praise and showing a lot of excitement every time he did it correctly. The nice thing about a goal like this is that there's a lot of natural positive reinforcement...when you say "hi" to people, they generally will smile or get excited to start talking to you (especially if you've never said hi to them before and now you are).

NATURAL ENVIRONMENT
After going through all the videos, we went into the hallway to practice. Luckily the staff were all great and would naturally say hello to Junior, and even some peers did as well. Being in the natural environment and interacting with a variety of people will help with generalization skills.  The progress that Junior made in those 10-15 minutes were pretty great.  Junior went from a 0% response to 60%, and continued averaging about a 70% response rate over the next 3 sessions.

MINIMUM-TO-MAXIMUM PROMPTING
While we would practice in the natural environment, I used a minimum-to-maximum prompting procedure. I would allow Junior to first respond independently, if he didn't respond then I would give a verbal prompt (i.e., "She just said hello, what do you say?"), if that didn't work then I would give a model (i.e., "Say hi"), then if that didn't work then I would give a physical prompt to wave his hand. He only ever ended up needing a verbal prompt (which never worked last year).

There are a lot of different techniques out there, sometimes it can work to your benefit to find ones that can be used effectively together, and you may have greater success.

Behavior and Positive Reinforcement

In my last post I talked about the ABCs of Behavior, which is a great way to collect data on behaviors that may be a concern.  But, what do you do with that data?  First, you look for patterns.

Let's say that the pattern you found was in the 'CONSEQUENCES' column.  Every time that Sara screamed, she would receive attention.  One thing to remember is that attention is attention whether it's positive or negative attention.

Now comes the tricky part, changing the behavior.  I think that an important part of this is first recognizing what you (the adult) needs to change in your own behavior before attempting to change the child's behavior.

When it comes to 'attention', how we react to behaviors becomes very important.  We may need to change how we react to certain situations, and we may need to give more attention whenever we see positive behaviors displayed by a child.  For every correction or negative comment that is given, a child should receive at least 4 positive comments/interactions.

Here are some ideas to help you as you make a plan (I'm sure there's many more ideas that many of you can come up with too)

• Increase your positive reinforcement during times when the child is acting appropriately (not just following a "tantrum", but throughout the day)
• Plan times to spend one on one to play, especially if you know that your child is seeking attention.
• When a child is having a "tantrum" compliment the other kids who are acting appropriately, and be specific about what you like that they are doing.  Then when the child having a hard time does any of those things, immediately compliment him/her, reinforcing the behaviors you do like.  If there are no other kids around, it's fine to compliment the stuffed bear sitting in the chair for sitting quietly.
• Teach a replacement behavior.  What do you want the child to do instead of screaming?  Help walk them through the steps, then give positive reinforcement (or natural consequences of giving them what they want, if appropriate) when they use the replacement behavior.
• Ignore the inappropriate behavior (if it's safe), but follow up with positive reinforcement the second they are doing anything appropriate.  If they are screaming, compliment them the second they stop.  Be specific in your compliments though.  Instead of "good job" say "I like how you have a quiet voice and are using your words to tell me what you want."

Something to remember is that there is something called an extinction burst which means that often times the behavior will get worst before it gets better.  Sometimes the limits have to be tried before the child realizes it's not working.  So don't give up, these things take time.  Consistency is the key, and some of the most important times are not when the child is in the middle of the crisis cycle, but when they are calm and happy.  Positive reinforcement can be pretty powerful.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention for Children with Autism

photo credit: Sebastian Anthony via photopin cc

In my last post I talked about the ABCs of Behavior, which is a great way to collect data on behaviors that may be a concern.  But, what do you do with that data?  First, you look for patterns.

Let's say that the pattern you found was in the 'CONSEQUENCES' column.  Every time that Sara screamed, she would receive attention.  One thing to remember is that attention is attention whether it's positive or negative attention.

Now comes the tricky part, changing the behavior.  I think that an important part of this is first recognizing what you (the adult) needs to change in your own behavior before attempting to change the child's behavior.

When it comes to 'attention', how we react to behaviors becomes very important.  We may need to change how we react to certain situations, and we may need to give more attention whenever we see positive behaviors displayed by a child.  For every correction or negative comment that is given, a child should receive at least 4 positive comments/interactions.

Here are some ideas to help you as you make a plan (I'm sure there's many more ideas that many of you can come up with too)

• Increase your positive reinforcement during times when the child is acting appropriately (not just following a "tantrum", but throughout the day)
• Plan times to spend one on one to play, especially if you know that your child is seeking attention.
• When a child is having a "tantrum" compliment the other kids who are acting appropriately, and be specific about what you like that they are doing.  Then when the child having a hard time does any of those things, immediately compliment him/her, reinforcing the behaviors you do like.  If there are no other kids around, it's fine to compliment the stuffed bear sitting in the chair for sitting quietly.
• Teach a replacement behavior.  What do you want the child to do instead of screaming?  Help walk them through the steps, then give positive reinforcement (or natural consequences of giving them what they want, if appropriate) when they use the replacement behavior.
• Ignore the inappropriate behavior (if it's safe), but follow up with positive reinforcement the second they are doing anything appropriate.  If they are screaming, compliment them the second they stop.  Be specific in your compliments though.  Instead of "good job" say "I like how you have a quiet voice and are using your words to tell me what you want."

Something to remember is that there is something called an extinction burst which means that often times the behavior will get worst before it gets better.  Sometimes the limits have to be tried before the child realizes it's not working.  So don't give up, these things take time.  Consistency is the key, and some of the most important times are not when the child is in the middle of the crisis cycle, but when they are calm and happy.  Positive reinforcement can be pretty powerful.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention for Children with Autism

photo credit: Sebastian Anthony via photopin cc

ABC's of Behavior

I first learned about the ABC's of Behavior when I was a teenager working at a group home for people with developmental disabilities.  The women I worked with had varying ability levels, and a few of them had tendencies towards aggression.  Some days it was very obvious why they were upset, but other times it could be a puzzle.

These ABC's have come to be very important throughout my career of working in various environments, whether I was working in group homes, summer camps, schools, care centers, workshops, or homes.

So, what are the ABC's of Behavior?

A=Antecedent
B=Behavior
C=Consequence

Another important thing to consider are Setting Events, which I wrote about in another post.

If you understand these ABC's, you may be able to gain valuable information that may help reduce some behavioral outbursts.

Antecedent:  What happened right before the behavior.
Behavior:  What did the behavior look like, this should be specific rather than general.  Instead of saying "she had a tantrum", you should describe it "she screamed for 5 minutes."
Consequence: What happened right after the behavior.  This is not necessarily referring to how the child was disciplined.  It is whatever happened directly following the behavior (i.e., peers in the class laughed, the teacher stopped and asked the student to stop, the student was escorted out of the class, etc.)

Using this ABC form can help you start to recognize patterns in an individual's behaviors.  If you are looking to reduce the frequency of a behavior, you will want to be specific on which behavior you are tracking, and be as specific as possible when filling out the form so you have lots of information.

You will want to track the behavior at least 1-2 weeks, and you should take data every time that behavior occurs.  You can track multiple behaviors at a time, but to begin, I would suggest tracking the behavior that is of greatest concern.

Once you have some data, and have some ideas of why the behavior you are tracking is occurring, you can start making a plan.  Check out my next post, as I will discuss some ideas to help you with this.

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Services For Children With Autism

I first learned about the ABC's of Behavior when I was a teenager working at a group home for people with developmental disabilities.  The women I worked with had varying ability levels, and a few of them had tendencies towards aggression.  Some days it was very obvious why they were upset, but other times it could be a puzzle.

These ABC's have come to be very important throughout my career of working in various environments, whether I was working in group homes, summer camps, schools, care centers, workshops, or homes.

So, what are the ABC's of Behavior?

A=Antecedent
B=Behavior
C=Consequence

Another important thing to consider are Setting Events, which I wrote about in another post.

If you understand these ABC's, you may be able to gain valuable information that may help reduce some behavioral outbursts.

Antecedent:  What happened right before the behavior.
Behavior:  What did the behavior look like, this should be specific rather than general.  Instead of saying "she had a tantrum", you should describe it "she screamed for 5 minutes."
Consequence: What happened right after the behavior.  This is not necessarily referring to how the child was disciplined.  It is whatever happened directly following the behavior (i.e., peers in the class laughed, the teacher stopped and asked the student to stop, the student was escorted out of the class, etc.)

Using this ABC form can help you start to recognize patterns in an individual's behaviors.  If you are looking to reduce the frequency of a behavior, you will want to be specific on which behavior you are tracking, and be as specific as possible when filling out the form so you have lots of information.

You will want to track the behavior at least 1-2 weeks, and you should take data every time that behavior occurs.  You can track multiple behaviors at a time, but to begin, I would suggest tracking the behavior that is of greatest concern.

Once you have some data, and have some ideas of why the behavior you are tracking is occurring, you can start making a plan.  Check out my next post, as I will discuss some ideas to help you with this.

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Services For Children With Autism

Creating A Summer Picture Schedule For Your Child With Autism

I can't believe it's June!  The pool is open, kids are getting out of school, and it's time for summer fun.

Most kids seem to love summer, however a lot of kids with special needs have a difficult time during the summer months.  Some of this can be attributed to the fact that their schedule is suddenly thrown out of whack.  They may not understand why the bus stopped picking them up and why suddenly no one is doing what they're supposed to be doing.  They may not understand why those teachers that they see every day and they thought loved them have suddenly disappeared out of their lives.  There's a lot that we just expect our kids to deal with.

I had one student that I found out when we would have school breaks (I was on a year-round schedule), he would sleep with his backpack.  I also found out that at the end of the year and it was summer break he would sleep with a picture of me.  The funny thing is that it was his "no school" sign, so it was a picture of me with an X through it.  The thing that his mom and I loved about this was that he was communicating to us that he loved school.  He was non-verbal, and had very little communication.

Some (not all) kids with autism thrive on having a routine.  Behavior problems may decrease, they may be able to learn better, and a lot of times they appear to be happier.  This can be a good thing because we (the adults) can easily help with that.  At times this can also be a difficult thing if flexibility is not taught and used during these routines.

There are different ways to establish a routine.  One way is through picture schedules.  With pictures, a child is able to predict what is going to happen during their day.  They don't have to be so specific and every minute doesn't have to be planned out, but having some general idea of the day can help immensely.  If your child is at a reading level, doing a picture schedule left to right gives good left to right orientation practice.  Going from top to bottom is another way to do it, and is easier for some kids.

The order that you do things is not important, actually I would encourage you to mix things up every once in a while because it can help with the flexibility.  The thing that is routine and stays the same for them is that they know where the schedule is, and they know that it will show what is going to happen. When you go on outings, you don't necessarily have to have where you are going on the schedule, but just that you're going.  However, it would be good to have a routine built in of explaining where you are going whether it's with a social story, or just explaining it.  This way you can plan new activities without having to create new pictures all the time.  You can also add unexpected events into the schedule this way.

Here is a sample schedule,  you may want less pictures or more, it's really up to you  (I just got a bunch of pictures off of google images)  The best placement for a schedule is at eye level for the child and somewhere that they can go look at it independently when they want to:

Breakfast

Get Dressed

Read

Play

Lunch

Outing

TV Time

Play Outside

Dinner

Family Activity

Get dressed for bed

Brush Teeth

Go To Sleep

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Kids With Autism

I can't believe it's June!  The pool is open, kids are getting out of school, and it's time for summer fun.

Most kids seem to love summer, however a lot of kids with special needs have a difficult time during the summer months.  Some of this can be attributed to the fact that their schedule is suddenly thrown out of whack.  They may not understand why the bus stopped picking them up and why suddenly no one is doing what they're supposed to be doing.  They may not understand why those teachers that they see every day and they thought loved them have suddenly disappeared out of their lives.  There's a lot that we just expect our kids to deal with.

I had one student that I found out when we would have school breaks (I was on a year-round schedule), he would sleep with his backpack.  I also found out that at the end of the year and it was summer break he would sleep with a picture of me.  The funny thing is that it was his "no school" sign, so it was a picture of me with an X through it.  The thing that his mom and I loved about this was that he was communicating to us that he loved school.  He was non-verbal, and had very little communication.

Some (not all) kids with autism thrive on having a routine.  Behavior problems may decrease, they may be able to learn better, and a lot of times they appear to be happier.  This can be a good thing because we (the adults) can easily help with that.  At times this can also be a difficult thing if flexibility is not taught and used during these routines.

There are different ways to establish a routine.  One way is through picture schedules.  With pictures, a child is able to predict what is going to happen during their day.  They don't have to be so specific and every minute doesn't have to be planned out, but having some general idea of the day can help immensely.  If your child is at a reading level, doing a picture schedule left to right gives good left to right orientation practice.  Going from top to bottom is another way to do it, and is easier for some kids.

The order that you do things is not important, actually I would encourage you to mix things up every once in a while because it can help with the flexibility.  The thing that is routine and stays the same for them is that they know where the schedule is, and they know that it will show what is going to happen. When you go on outings, you don't necessarily have to have where you are going on the schedule, but just that you're going.  However, it would be good to have a routine built in of explaining where you are going whether it's with a social story, or just explaining it.  This way you can plan new activities without having to create new pictures all the time.  You can also add unexpected events into the schedule this way.

Here is a sample schedule,  you may want less pictures or more, it's really up to you  (I just got a bunch of pictures off of google images)  The best placement for a schedule is at eye level for the child and somewhere that they can go look at it independently when they want to:

Breakfast

Get Dressed

Read

Play

Lunch

Outing

TV Time

Play Outside

Dinner

Family Activity

Get dressed for bed

Brush Teeth

Go To Sleep

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Kids With Autism

An Amazing Utah School For Kids With Autism

Wow, I did not do well at blogging in May!  Luckily, it's a new month, and I am ready to go.  It's been an interesting month for me, full of change, but exciting changes.  One of those changes will take place in August, but it was this month that I had to make that decision.

At the beginning of the month I was contacted by Clear Horizons Academy and I was asked if I would be interested in coming to their school to help create a preschool program.  Clear Horizons is a private school in Utah County for kids with autism.  They serve all ages, and they are continually growing each year.  I was flattered by this invitation.

It wasn't as easy a decision as it seems like it should have been, partly because it's just another big life change for me and would require some sacrifices in other areas of my life.  Another factor for me was that I don't live in Utah County.  All in all though, I feel like I will be sacrificing very little for a big opportunity in the end.  For years I have wanted to start my own school, and that's still in the works, but I think this opportunity to work in a private school and to help create something I love will help prepare me for future endeavors.  The other thing about Clear Horizons is that they are the only school in Utah that I know of who's foundation is based on DIR/Floortime, which is what PLAY Project is based on.

So for any of you families who are looking for a preschool program for your little ones with autism, come check out Clear Horizons!

I am really excited for this new adventure.  Because of time, it will force me to limit my private clients, however I have some ideas formulating.  I'm hoping to be able to offer some group therapy sessions with families after school, and some parenting classes as well.  Clear Horizons is great, and they are willing to allow me to rent out space in their incredible building.  They built this building just last year, and it was specifically made for kids with autism in mind.  It has a specialized playground, a sensory room, classrooms with swings, and lots of natural light.  I love it.

I'm excited for new opportunities.

Wow, I did not do well at blogging in May!  Luckily, it's a new month, and I am ready to go.  It's been an interesting month for me, full of change, but exciting changes.  One of those changes will take place in August, but it was this month that I had to make that decision.

At the beginning of the month I was contacted by Clear Horizons Academy and I was asked if I would be interested in coming to their school to help create a preschool program.  Clear Horizons is a private school in Utah County for kids with autism.  They serve all ages, and they are continually growing each year.  I was flattered by this invitation.

It wasn't as easy a decision as it seems like it should have been, partly because it's just another big life change for me and would require some sacrifices in other areas of my life.  Another factor for me was that I don't live in Utah County.  All in all though, I feel like I will be sacrificing very little for a big opportunity in the end.  For years I have wanted to start my own school, and that's still in the works, but I think this opportunity to work in a private school and to help create something I love will help prepare me for future endeavors.  The other thing about Clear Horizons is that they are the only school in Utah that I know of who's foundation is based on DIR/Floortime, which is what PLAY Project is based on.

So for any of you families who are looking for a preschool program for your little ones with autism, come check out Clear Horizons!

I am really excited for this new adventure.  Because of time, it will force me to limit my private clients, however I have some ideas formulating.  I'm hoping to be able to offer some group therapy sessions with families after school, and some parenting classes as well.  Clear Horizons is great, and they are willing to allow me to rent out space in their incredible building.  They built this building just last year, and it was specifically made for kids with autism in mind.  It has a specialized playground, a sensory room, classrooms with swings, and lots of natural light.  I love it.

I'm excited for new opportunities.

Sensory Friendly Concert

A couple weeks ago I had the opportunity to go to lunch with Jaycie Voorhees.  She's a music therapist in Utah.  She is so great, and I am so excited for what she is doing in our community.  We're hoping that we'll be able to do some work together in the future :)

She's putting on a Sensory Friendly Concert next week.  Everyone is invited.  It sounds like a lot of fun with great entertainment and it will be interactive for the kiddos.  Bring the whole family, and help spread the word!  Jaycie is hoping that this will be something they can start doing on a regular basis if there is enough interest.

A couple weeks ago I had the opportunity to go to lunch with Jaycie Voorhees.  She's a music therapist in Utah.  She is so great, and I am so excited for what she is doing in our community.  We're hoping that we'll be able to do some work together in the future :)

She's putting on a Sensory Friendly Concert next week.  Everyone is invited.  It sounds like a lot of fun with great entertainment and it will be interactive for the kiddos.  Bring the whole family, and help spread the word!  Jaycie is hoping that this will be something they can start doing on a regular basis if there is enough interest.

Embracing Autism

This weekend I was talking with a good friend of mine (Melissa), and she told me this awesome story.  I wanted to share.

Last week at school, Melissa's 10 year old cousin overheard a group of kids making fun of another kid.  The kid that they were making fun of has Autism.  So this 10 year old boy went over to the other kids, made them line up and started to give them a lecture.  He basically told them that just because people are different doesn't mean that we should treat them differently.  Everyone deserves to be treated well.

What a kid!

The story doesn't stop there.  Melissa's 10 year old cousin was told that he could only invite a handful of kids to his birthday party this year since they were having it at a place where you pay per person.  When he went home that day, he told his mom that there was a kid in his class that he wanted to invite because he never gets invited to parties since the other kids think he's weird.  He told his mom "Mom, he's not weird, he's just autistic."  He worried that this boy might not be able to come to the party because his parents always attend the field trips at school to help him, so they made a special invitation to give to him at school.  There was an invitation for the kid, and a note to the mom telling her that they would really like her son to come to the birthday party, but they understood that he may want her to stay and that she is more than welcome to stay at the party as well.

What a family!

I feel like this is one of those moments where you would be so happy as a parent...on both sides of the story.  I hope that Melissa's cousin realizes that he is an inspiration, and that an attitude like that can literally change the world.  As he goes throughout his life, he will continue to have a big impact on others around him, and will teach acceptance of differences through his words and his example.  He will be a hero to many :)

To his parents, I want to say thank you for raising your son in a way that he would be able to make these beautiful decisions on his own without worrying about who he's going to impress or make upset.  That is true integrity, and it's a difficult thing to instill in others.

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention for Children with Autism

 photo credit: susivinh via photopin cc

This weekend I was talking with a good friend of mine (Melissa), and she told me this awesome story.  I wanted to share.

Last week at school, Melissa's 10 year old cousin overheard a group of kids making fun of another kid.  The kid that they were making fun of has Autism.  So this 10 year old boy went over to the other kids, made them line up and started to give them a lecture.  He basically told them that just because people are different doesn't mean that we should treat them differently.  Everyone deserves to be treated well.

What a kid!

The story doesn't stop there.  Melissa's 10 year old cousin was told that he could only invite a handful of kids to his birthday party this year since they were having it at a place where you pay per person.  When he went home that day, he told his mom that there was a kid in his class that he wanted to invite because he never gets invited to parties since the other kids think he's weird.  He told his mom "Mom, he's not weird, he's just autistic."  He worried that this boy might not be able to come to the party because his parents always attend the field trips at school to help him, so they made a special invitation to give to him at school.  There was an invitation for the kid, and a note to the mom telling her that they would really like her son to come to the birthday party, but they understood that he may want her to stay and that she is more than welcome to stay at the party as well.

What a family!

I feel like this is one of those moments where you would be so happy as a parent...on both sides of the story.  I hope that Melissa's cousin realizes that he is an inspiration, and that an attitude like that can literally change the world.  As he goes throughout his life, he will continue to have a big impact on others around him, and will teach acceptance of differences through his words and his example.  He will be a hero to many :)

To his parents, I want to say thank you for raising your son in a way that he would be able to make these beautiful decisions on his own without worrying about who he's going to impress or make upset.  That is true integrity, and it's a difficult thing to instill in others.

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention for Children with Autism

 photo credit: susivinh via photopin cc

Disneyland!

Sorry, I haven't had a post for a week.  I went out of town for a week, and failed to have posts ready before I left.

So I just spent a week in California with beautiful weather, and a lot of time with Mickey and Goofy :)  I am lucky and I have the best family ever.  I got to spend a week with my entire family, and it was so much fun.  My nieces and nephews are the perfect ages for Disneyland, so we had a blast.

Disneyland was always our family vacation growing up, which I didn't mind.  However, as soon as I graduated High School, I did learn that there are a lot of amazing places out there to travel to.  I love traveling.

Disneyland or Disney World with my nieces and nephews is so much fun though.  My favorite ride has always been Peter Pan, probably because I always have wished that I could fly :)  Now I really like the new Cars ride and also the Toy Story ride.

This year we went to the World of Colors for the first time which is a huge water show, and I have to say it was pretty amazing.  I also saw the fireworks one night and Fantasmic.  We did it all.

One special experience I had was when I was getting off a ride with my 10 year old niece and there were some people that were waiting to get on, and they did not have to wait in line.  She asked me what they were doing and why they didn't have to go through the line.  They had some autism awareness shirts on, so I had the opportunity to explain to her how awesome Disney is (although I have heard they may be changing the program due to people taking advantage of the program without having a disability, which is really sad that people do that.)

I explained a little to her about how some people have special needs and have much more difficult lives than we do, so what Disney does is they allow them to be able to have the best time they can at the park with their families without having to worry about standing in line.  I also explained that for some families if they had to stand in line, they would never have the opportunity to go to Disneyland because it would be too hard.

I love when I get little opportunities to explain things like this to the kids in my life (and the adults too.)

Sorry, I haven't had a post for a week.  I went out of town for a week, and failed to have posts ready before I left.

So I just spent a week in California with beautiful weather, and a lot of time with Mickey and Goofy :)  I am lucky and I have the best family ever.  I got to spend a week with my entire family, and it was so much fun.  My nieces and nephews are the perfect ages for Disneyland, so we had a blast.

Disneyland was always our family vacation growing up, which I didn't mind.  However, as soon as I graduated High School, I did learn that there are a lot of amazing places out there to travel to.  I love traveling.

Disneyland or Disney World with my nieces and nephews is so much fun though.  My favorite ride has always been Peter Pan, probably because I always have wished that I could fly :)  Now I really like the new Cars ride and also the Toy Story ride.

This year we went to the World of Colors for the first time which is a huge water show, and I have to say it was pretty amazing.  I also saw the fireworks one night and Fantasmic.  We did it all.

One special experience I had was when I was getting off a ride with my 10 year old niece and there were some people that were waiting to get on, and they did not have to wait in line.  She asked me what they were doing and why they didn't have to go through the line.  They had some autism awareness shirts on, so I had the opportunity to explain to her how awesome Disney is (although I have heard they may be changing the program due to people taking advantage of the program without having a disability, which is really sad that people do that.)

I explained a little to her about how some people have special needs and have much more difficult lives than we do, so what Disney does is they allow them to be able to have the best time they can at the park with their families without having to worry about standing in line.  I also explained that for some families if they had to stand in line, they would never have the opportunity to go to Disneyland because it would be too hard.

I love when I get little opportunities to explain things like this to the kids in my life (and the adults too.)

Sensory Overload - Autism and the Doctor's Office

Sorry!  I meant to post this earlier.

I was trying to think of instances when someone might be excited to go to the doctor.  I asked a friend, and she came up with a few.  When a woman is going to find out if she's pregnant, when you're having a procedure done that will make your life better...like lasik eye surgery, when you know it's the last time you have to go after a long series of visits (but my guess is that you're more excited about the prospects of not having to go again rather than actually going.)  Ok, I guess there's a few, but let's be honest...even these visits cause a lot of anxiety.  When I had lasik eye surgery done, they offered Valium for the anxiety.

My conclusion...doctor visits cause anxiety.  And let's recall from my post about the brain, that the amygdala (it's weakness being low tolerance for stress and anxiety) is 4 times as big in a individual with autism.

Ok, so here goes my list of some (not all) reasons why going to the doctor can cause sensory overload for some kids (and adults) with autism.  In a future post I will share an experience that one mother shared with me of how her doctor made it such a successful visit with her son with autism.

• The anxiety of going to the unknown
• This trip is not part of my daily routine
• When we arrive, we have to wait to check in
• Mom or dad is filling out paperwork instead of paying attention to me
• I get yelled at every time I walk away 
• Florescent lights flickering
• Phones ringing
• TV playing, but it's not my favorite show
• Waiting to see the doctor
• Someone calls my name, and we are taken through a door to the unknown
• They make me stand on a scary looking machine to weigh me, but I don't know what that means
• I get in trouble when I don't stand still on the scary machine
• I am taken to a little room, and I have to wait...again
• They make me sit high in the air on some crinkly paper that doesn't feel good
• It smells weird
• There are objects around me that don't look familiar
• A stranger comes in and gets in my space, looking at my eyes, in my ears, in my mouth, etc.
• This same stranger has a some weird things coming out of his ears and he wants to put it on my heart, but I don't know why.  It's cold and uncomfortable.
• Sometimes another stranger comes in with pokey things and she stabs me with them, and it hurts
• After I cry for a while, I get to leave

If you liked this post, check out Sensory Overload at the Grocery Store and Grocery Store Intervention.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

photo credit: Joe Shlabotnik via photopin cc

Sorry!  I meant to post this earlier.

I was trying to think of instances when someone might be excited to go to the doctor.  I asked a friend, and she came up with a few.  When a woman is going to find out if she's pregnant, when you're having a procedure done that will make your life better...like lasik eye surgery, when you know it's the last time you have to go after a long series of visits (but my guess is that you're more excited about the prospects of not having to go again rather than actually going.)  Ok, I guess there's a few, but let's be honest...even these visits cause a lot of anxiety.  When I had lasik eye surgery done, they offered Valium for the anxiety.

My conclusion...doctor visits cause anxiety.  And let's recall from my post about the brain, that the amygdala (it's weakness being low tolerance for stress and anxiety) is 4 times as big in a individual with autism.

Ok, so here goes my list of some (not all) reasons why going to the doctor can cause sensory overload for some kids (and adults) with autism.  In a future post I will share an experience that one mother shared with me of how her doctor made it such a successful visit with her son with autism.

• The anxiety of going to the unknown
• This trip is not part of my daily routine
• When we arrive, we have to wait to check in
• Mom or dad is filling out paperwork instead of paying attention to me
• I get yelled at every time I walk away 
• Florescent lights flickering
• Phones ringing
• TV playing, but it's not my favorite show
• Waiting to see the doctor
• Someone calls my name, and we are taken through a door to the unknown
• They make me stand on a scary looking machine to weigh me, but I don't know what that means
• I get in trouble when I don't stand still on the scary machine
• I am taken to a little room, and I have to wait...again
• They make me sit high in the air on some crinkly paper that doesn't feel good
• It smells weird
• There are objects around me that don't look familiar
• A stranger comes in and gets in my space, looking at my eyes, in my ears, in my mouth, etc.
• This same stranger has a some weird things coming out of his ears and he wants to put it on my heart, but I don't know why.  It's cold and uncomfortable.
• Sometimes another stranger comes in with pokey things and she stabs me with them, and it hurts
• After I cry for a while, I get to leave

If you liked this post, check out Sensory Overload at the Grocery Store and Grocery Store Intervention.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

photo credit: Joe Shlabotnik via photopin cc

Autism and the Brain

Last week I attended an Autism Conference at Utah Valley University.  One of the workshops I attended was about the neurological difference associated with ASD.  I thought it was so interesting, and I learned a lot so I wanted to share it with you.  The presenter was Brandon Condie, BCBA, LPC.

He talked about 5 main areas of the brain, including the amygdala, hippocampus, frontal lobe, corpus callosum, and cerebellum.  The thing that I found interesting was the strengths and weaknesses of each of those areas.  It just makes so much sense if you know many individuals that are affected with autism.

Here we go.

Amygdala.  In an individual with autism, this area is enlarged.

• Strengths include improved memory for interests and details.  Makes total sense for those individuals who know EVERYTHING about their special interest.  Makes sense for those who have Savant skills.
• Weaknesses include a low tolerance for stress and/or anxiety.  When I heard Temple Grandin speak last year she mentioned that her amygdala is 4 times the size of a typical brain, which meant that her fear center was 4 times as big.  We see this a lot where a situation that doesn't seem frightening to us may be completely overwhelming to an individual with autism.  This explains a lot.

Hippocampus.  This area is also enlarged in an individual with autism.

• Strengths include being logical, and is systems oriented.  Many individuals with autism excel in areas like engineering, math, etc.  We marvel at those kiddos who are unable to communicate, yet they are able to navigate things like the dvd player, ipads, computers, etc. with very little help and at a very young age.
• Weaknesses include perseveration.  We see this in a lot of individuals with autism, once they are focused on something it is difficult to change directions.  Whether it is a topic of conversation, lining things up, or making sure everything is where they feel like it needs to be.

Cerebellum.  In an individual with autism, they may have overloaded white matter.

• Strengths include a need for routine, and becoming an expert at a task.  As many parents know, routines and predictability are so important for individuals with autism.
• Weaknesses include unsteadiness, delayed physical or verbal response, and anxiety surrounding sudden change.

Frontal Lobe.  The frontal lobe is enlarged due to excessive white matter.

• Strengths include being visual learners.  Temple Grandin talks a lot about how she sees the world in pictures, and all her memories are in pictures.  That's why she's so good at what she does.
• Weaknesses include having a difficult time with abstract thought.  This may be part of why social interactions are so difficult as well because they are not concrete.  Some of our rules as pertaining to social interactions are abstract.

Corpus Callosum.   This area is undersized.  The corpus callosum links the two hemispheres of the brains and is the source for effective communication between the two hemispheres.

• Strengths include being able to hyper-focus on detail
• Weaknesses include missing the "bigger picture" and being able to bring concepts together.

Learning about this information was so eye opening for me.  I've worked with a lot of kids with autism, and I see common characteristics and I know how to work with their strengths and their areas of struggle, but learning about the brain helps me to see more of the WHY. 

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

photo credit: Patrick Hoesly via photopin cc

Last week I attended an Autism Conference at Utah Valley University.  One of the workshops I attended was about the neurological difference associated with ASD.  I thought it was so interesting, and I learned a lot so I wanted to share it with you.  The presenter was Brandon Condie, BCBA, LPC.

He talked about 5 main areas of the brain, including the amygdala, hippocampus, frontal lobe, corpus callosum, and cerebellum.  The thing that I found interesting was the strengths and weaknesses of each of those areas.  It just makes so much sense if you know many individuals that are affected with autism.

Here we go.

Amygdala.  In an individual with autism, this area is enlarged.

• Strengths include improved memory for interests and details.  Makes total sense for those individuals who know EVERYTHING about their special interest.  Makes sense for those who have Savant skills.
• Weaknesses include a low tolerance for stress and/or anxiety.  When I heard Temple Grandin speak last year she mentioned that her amygdala is 4 times the size of a typical brain, which meant that her fear center was 4 times as big.  We see this a lot where a situation that doesn't seem frightening to us may be completely overwhelming to an individual with autism.  This explains a lot.

Hippocampus.  This area is also enlarged in an individual with autism.

• Strengths include being logical, and is systems oriented.  Many individuals with autism excel in areas like engineering, math, etc.  We marvel at those kiddos who are unable to communicate, yet they are able to navigate things like the dvd player, ipads, computers, etc. with very little help and at a very young age.
• Weaknesses include perseveration.  We see this in a lot of individuals with autism, once they are focused on something it is difficult to change directions.  Whether it is a topic of conversation, lining things up, or making sure everything is where they feel like it needs to be.

Cerebellum.  In an individual with autism, they may have overloaded white matter.

• Strengths include a need for routine, and becoming an expert at a task.  As many parents know, routines and predictability are so important for individuals with autism.
• Weaknesses include unsteadiness, delayed physical or verbal response, and anxiety surrounding sudden change.

Frontal Lobe.  The frontal lobe is enlarged due to excessive white matter.

• Strengths include being visual learners.  Temple Grandin talks a lot about how she sees the world in pictures, and all her memories are in pictures.  That's why she's so good at what she does.
• Weaknesses include having a difficult time with abstract thought.  This may be part of why social interactions are so difficult as well because they are not concrete.  Some of our rules as pertaining to social interactions are abstract.

Corpus Callosum.   This area is undersized.  The corpus callosum links the two hemispheres of the brains and is the source for effective communication between the two hemispheres.

• Strengths include being able to hyper-focus on detail
• Weaknesses include missing the "bigger picture" and being able to bring concepts together.

Learning about this information was so eye opening for me.  I've worked with a lot of kids with autism, and I see common characteristics and I know how to work with their strengths and their areas of struggle, but learning about the brain helps me to see more of the WHY. 

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

photo credit: Patrick Hoesly via photopin cc

Repetitive Behaviors and Autism

So I've talked about the first two areas of concern in autism, which are social interactions and communication.  The last area is repetitive behaviors.

As a recap, according to the DSM IV these are the requirements for a diagnosis of autism.

• At least two symptoms from the area of Social Interaction are present
• At least one symptom from the area of Communication is present
• At least one symptom from the area of Repetitive Behaviors is present
• A total of 6 (or more) items are present from the 3 areas listed above
• Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
• Social interaction
• Language as used in social communication
• Symbolic or imaginative play
• The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

Ok, let's talk about Repetitive Behaviors.  Like I said above, at least one of the following is present.

• Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
• Apparently inflexible adherence to specific, nonfunctional routines or rituals
• Stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole body movements)
• Persistent preoccupation with parts of objects

What does this look like?

Restricted patterns of interest.  The key to this area is the intensity and focus.  We all have interests, but it is the intensity and focus on that interest that can become disruptive to every day life.  For some it may be a subject like trains, dinosaurs, trucks, star wars, etc.  It may become the only thing the individual will talk about and can have an effect on relationships and school depending on how focused they are on that subject.  For others it may be in lining things up, or matching objects.  This can affect ones life when the intensity is so strong that they have a meltdown every time things are not how they would like them to be lined up.  

Specific, nonfunctional routines or rituals.  Just like we have our own rules for things, and I'm sure that some individuals with autism don't understand our rules...some individuals with autism have their own rules and we just don't get it.  I had a student and his "rule" was that he had to enter the building through a certain door.  I didn't know about this "rule" and it took a while before I figured it out, but if he went through the right door instead of the left door (even if we already made it halfway down the hallway) he would have to turn around go back outside and come in through the left door.  This was a behavior that was specific, nonfunctional and turned into a ritual.

Repetitive motor mannerisms.  Many of us have little movements that we do when we are in stressful moments, or when we are trying to pay attention.  For example, when we are sitting in a meeting all day, we tend to get restless.  We start to bounce our leg, or tap our pencil on the desk.  Once again what this is looking at is the intensity and focus.  Many individuals with autism have repetitive behaviors that may begin as a coping mechanism for them but can easily turn into habit.  Some of these repetitive behaviors may be hand flapping, walking on tip toes, spinning, darting across the room, flicking their fingers in front of their eyes, etc.

Preoccupation with parts of objects.  Sometimes you will find that individuals with autism focus on parts of objects rather than looking at the object as a whole.  For example rather than playing with a toy car, the child may be overly focused on the tires.  Instead of using the toy functionally, they may only spin the tires.

Repetitive behaviors can be all consuming and may affect an individuals ability to function fully in their environment, however that information can be very useful as we learn to interact with each individual. 

If you have any concerns about your child's development, please contact your doctor.

Joy Mano

Utah PLAY Project Home Consultant

Early Childhood Autism Services

photo credit: KellBailey via photopin cc

So I've talked about the first two areas of concern in autism, which are social interactions and communication.  The last area is repetitive behaviors.

As a recap, according to the DSM IV these are the requirements for a diagnosis of autism.

• At least two symptoms from the area of Social Interaction are present
• At least one symptom from the area of Communication is present
• At least one symptom from the area of Repetitive Behaviors is present
• A total of 6 (or more) items are present from the 3 areas listed above
• Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
• Social interaction
• Language as used in social communication
• Symbolic or imaginative play
• The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.

Ok, let's talk about Repetitive Behaviors.  Like I said above, at least one of the following is present.

• Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
• Apparently inflexible adherence to specific, nonfunctional routines or rituals
• Stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole body movements)
• Persistent preoccupation with parts of objects

What does this look like?

Restricted patterns of interest.  The key to this area is the intensity and focus.  We all have interests, but it is the intensity and focus on that interest that can become disruptive to every day life.  For some it may be a subject like trains, dinosaurs, trucks, star wars, etc.  It may become the only thing the individual will talk about and can have an effect on relationships and school depending on how focused they are on that subject.  For others it may be in lining things up, or matching objects.  This can affect ones life when the intensity is so strong that they have a meltdown every time things are not how they would like them to be lined up.  

Specific, nonfunctional routines or rituals.  Just like we have our own rules for things, and I'm sure that some individuals with autism don't understand our rules...some individuals with autism have their own rules and we just don't get it.  I had a student and his "rule" was that he had to enter the building through a certain door.  I didn't know about this "rule" and it took a while before I figured it out, but if he went through the right door instead of the left door (even if we already made it halfway down the hallway) he would have to turn around go back outside and come in through the left door.  This was a behavior that was specific, nonfunctional and turned into a ritual.

Repetitive motor mannerisms.  Many of us have little movements that we do when we are in stressful moments, or when we are trying to pay attention.  For example, when we are sitting in a meeting all day, we tend to get restless.  We start to bounce our leg, or tap our pencil on the desk.  Once again what this is looking at is the intensity and focus.  Many individuals with autism have repetitive behaviors that may begin as a coping mechanism for them but can easily turn into habit.  Some of these repetitive behaviors may be hand flapping, walking on tip toes, spinning, darting across the room, flicking their fingers in front of their eyes, etc.

Preoccupation with parts of objects.  Sometimes you will find that individuals with autism focus on parts of objects rather than looking at the object as a whole.  For example rather than playing with a toy car, the child may be overly focused on the tires.  Instead of using the toy functionally, they may only spin the tires.

Repetitive behaviors can be all consuming and may affect an individuals ability to function fully in their environment, however that information can be very useful as we learn to interact with each individual. 

If you have any concerns about your child's development, please contact your doctor.

Joy Mano

Utah PLAY Project Home Consultant

Early Childhood Autism Services

photo credit: KellBailey via photopin cc

Communication and Autism

On Monday I focused on the area of Social Interactions in regards to the DSM IV (how autism is diagnosed.)  Today I'm would like to continue on to Communication.  As I said in my last post, just because someone has some of these characteristics, does not necessarily mean they have autism.  They must also meet the criteria in the areas of Social Interaction and Repetitive Behaviors.

According to the DSM IV, at least one of the following are present.

• Delay in or total lack of, the development of spoken language (also without gestural communication)
• Individuals with adequate speech have a marked impairment in the ability to initiate or sustain conversations
• Stereotyped and repetitive use of language or idiosyncratic language
• Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

Spoken Language and Gestural Language.  Many times the lack of spoken language is the most obvious sign for parents that their child may have delays.  Typically, kids should have several  consistent words they are using by 18 months.  You would start seeing more gestural communication, like pointing, around 14 months.  Here is a great blog about language development (Playing With Words 365), and particularly, here is a post about red flags in communication.  It gives some great timelines on language development.

Initiating and Sustaining Conversations.  There are some kiddos who have tons of words they know, but making their words functional can be more difficult.  Conversations are a give and take process, we build relationships when we have good conversations.  Some kids may know how to talk, but they do not participate in a back and forth interactions with others.  Some kids are good at responding, and will answer questions, but will not go further than that.  Others will initiate, but will rarely let others respond, thus they are very good at the giving part, but not so much at the taking part.

Stereotyped and Repetitive Language.  Some parents will report that their children speak in movie quotes.  Sometimes it's in context with the situation, but a lot of times it is not.  Some kids may get fixated on certain phrases and will repeat them continuously.  Other kids will repeat what you say or other things they hear, this is called echolalia.  Echolalia includes when they immediately repeat what they hear, or they may also repeat what they heard hours ago.

Make-believe Play or Social Imitative Play.  Make-believe can be difficult for some kids with autism because it involves an understanding of what other people are feeling and doing.  It also requires imitation skills.  When playing with others in pretend play, this skill also requires that the child is able to see the points of view of other people and explain his/her point of view to them to create the experience that they want.  Many kids with autism prefer to play on their own, and may focus more on sensory type play.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

photo credit: Diego Dalmaso via photopin cc

On Monday I focused on the area of Social Interactions in regards to the DSM IV (how autism is diagnosed.)  Today I'm would like to continue on to Communication.  As I said in my last post, just because someone has some of these characteristics, does not necessarily mean they have autism.  They must also meet the criteria in the areas of Social Interaction and Repetitive Behaviors.

According to the DSM IV, at least one of the following are present.

• Delay in or total lack of, the development of spoken language (also without gestural communication)
• Individuals with adequate speech have a marked impairment in the ability to initiate or sustain conversations
• Stereotyped and repetitive use of language or idiosyncratic language
• Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

Spoken Language and Gestural Language.  Many times the lack of spoken language is the most obvious sign for parents that their child may have delays.  Typically, kids should have several  consistent words they are using by 18 months.  You would start seeing more gestural communication, like pointing, around 14 months.  Here is a great blog about language development (Playing With Words 365), and particularly, here is a post about red flags in communication.  It gives some great timelines on language development.

Initiating and Sustaining Conversations.  There are some kiddos who have tons of words they know, but making their words functional can be more difficult.  Conversations are a give and take process, we build relationships when we have good conversations.  Some kids may know how to talk, but they do not participate in a back and forth interactions with others.  Some kids are good at responding, and will answer questions, but will not go further than that.  Others will initiate, but will rarely let others respond, thus they are very good at the giving part, but not so much at the taking part.

Stereotyped and Repetitive Language.  Some parents will report that their children speak in movie quotes.  Sometimes it's in context with the situation, but a lot of times it is not.  Some kids may get fixated on certain phrases and will repeat them continuously.  Other kids will repeat what you say or other things they hear, this is called echolalia.  Echolalia includes when they immediately repeat what they hear, or they may also repeat what they heard hours ago.

Make-believe Play or Social Imitative Play.  Make-believe can be difficult for some kids with autism because it involves an understanding of what other people are feeling and doing.  It also requires imitation skills.  When playing with others in pretend play, this skill also requires that the child is able to see the points of view of other people and explain his/her point of view to them to create the experience that they want.  Many kids with autism prefer to play on their own, and may focus more on sensory type play.

Joy Mano

Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

photo credit: Diego Dalmaso via photopin cc

Social Interactions and Autism

According to the DSM IV (which I mentioned earlier will soon be DSM-5 as early as May 2013), at least two of the following are present in the area of Social Interaction when an individual is being diagnosed with autism.

• Marked impairments in the use of multiple nonverbal behaviors such as eye contact, facial expression, body posture, and gestures to regulate social interactions
• —Failure to develop peer relationships appropriate to developmental level
• —A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
• —A lack of social or emotional reciprocity

Now just because someone has some of these characteristics, doesn't mean they have autism. They also have to have symptoms in the areas of Communication and Repetitive Behaviors, which I will talk about next week.

Let's break this down a little.

Eye Contact.  Sometimes eye contact can be very aversive to a person with autism, you may get occasional glimpses here and there, but it can be fleeting.  As you go through your day, take note to how much we communicate with our eyes.  It can be very difficult to teach someone to communicate and read "eye language", it's all so subtle.  You can see how that can affect someone's social skills.

Facial Expression.  You may or may not have heard the expression "flat affect."  Sometimes individuals with autism show very little expressions through on their face.  They have the same expression when they're bored as they do when they're excited.  Other times you may find that their facial expressions are a bit rigid and unnatural.  Again, reading facial expressions can be difficult for some people with autism, but in general it's a bit easier to teach than reading the eyes.

Body Posture and Gestures.  How often do we communicate with gestures?  All the time!  Many times, young kids with autism are unable to follow a point or use a point themselves.  We point with our fingers, and we point with our eyes for joint attention.  We are having an interaction as we are both focused on the same thing.  Gestural communication is very important in our social interactions.  It is usually learned through imitation, which many kids with autism are lacking in.

Peer Relationships.  There are different types of play, and depending on the child's age, different types of peer interactions are more appropriate than others.  Usually when parents start to see the gap is when it is time that their child should start socializing with their peers (associative or cooperative play.)  For some kids, they would rather participate in solitary play away from everyone else.  Some kids are only able to play near others for short periods of time.  For other kids they may want to play with other kids, but they don't know how to join in, or they don't know how to participate.  Some kids are able to talk, but they lack the understanding that conversations should be a give and take exchange.  And some kids like playing with others, but they have a hard time when they don't have total control over the activity.  All of these things can affect peer relationships.

Sharing Enjoyment.  At a young age kids will pick up a toy to show their mom.  Typically a toddler will learn the phrase "look" or "look at me!" and will use it quite often.  Once again, that is part of joint attention.  Focusing together on one thing.  Some kids with autism will not participate in exchanges like this.

Social or Emotional Reciprocity. When we are connected to each other, we have back and forth interactions with one another.  We are able to read each others gestures, their tone of voice, their emotions, and their words.  We take these things as cues and we respond to them accordingly.  Many people with autism have a difficult time with this because they lack theory of mind.

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Services for Children with Autism

photo credit: MikeWren via photopin cc

According to the DSM IV (which I mentioned earlier will soon be DSM-5 as early as May 2013), at least two of the following are present in the area of Social Interaction when an individual is being diagnosed with autism.

• Marked impairments in the use of multiple nonverbal behaviors such as eye contact, facial expression, body posture, and gestures to regulate social interactions
• —Failure to develop peer relationships appropriate to developmental level
• —A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
• —A lack of social or emotional reciprocity

Now just because someone has some of these characteristics, doesn't mean they have autism. They also have to have symptoms in the areas of Communication and Repetitive Behaviors, which I will talk about next week.

Let's break this down a little.

Eye Contact.  Sometimes eye contact can be very aversive to a person with autism, you may get occasional glimpses here and there, but it can be fleeting.  As you go through your day, take note to how much we communicate with our eyes.  It can be very difficult to teach someone to communicate and read "eye language", it's all so subtle.  You can see how that can affect someone's social skills.

Facial Expression.  You may or may not have heard the expression "flat affect."  Sometimes individuals with autism show very little expressions through on their face.  They have the same expression when they're bored as they do when they're excited.  Other times you may find that their facial expressions are a bit rigid and unnatural.  Again, reading facial expressions can be difficult for some people with autism, but in general it's a bit easier to teach than reading the eyes.

Body Posture and Gestures.  How often do we communicate with gestures?  All the time!  Many times, young kids with autism are unable to follow a point or use a point themselves.  We point with our fingers, and we point with our eyes for joint attention.  We are having an interaction as we are both focused on the same thing.  Gestural communication is very important in our social interactions.  It is usually learned through imitation, which many kids with autism are lacking in.

Peer Relationships.  There are different types of play, and depending on the child's age, different types of peer interactions are more appropriate than others.  Usually when parents start to see the gap is when it is time that their child should start socializing with their peers (associative or cooperative play.)  For some kids, they would rather participate in solitary play away from everyone else.  Some kids are only able to play near others for short periods of time.  For other kids they may want to play with other kids, but they don't know how to join in, or they don't know how to participate.  Some kids are able to talk, but they lack the understanding that conversations should be a give and take exchange.  And some kids like playing with others, but they have a hard time when they don't have total control over the activity.  All of these things can affect peer relationships.

Sharing Enjoyment.  At a young age kids will pick up a toy to show their mom.  Typically a toddler will learn the phrase "look" or "look at me!" and will use it quite often.  Once again, that is part of joint attention.  Focusing together on one thing.  Some kids with autism will not participate in exchanges like this.

Social or Emotional Reciprocity. When we are connected to each other, we have back and forth interactions with one another.  We are able to read each others gestures, their tone of voice, their emotions, and their words.  We take these things as cues and we respond to them accordingly.  Many people with autism have a difficult time with this because they lack theory of mind.

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Services for Children with Autism

photo credit: MikeWren via photopin cc