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

Parent Testimonial of the PLAY Project

“My Name is Rachael, I have a 4 year old Autistic son named Tyler. I started doing Play Project two years ago with Joy.  Play Project for me has been a new life, a new life style, and a necessity in our lives.  Before we started working with Tyler on Play Project we could not get him to respond to his name, show us what he wanted, or even calm him down.  Play Project is something that I work on each and every day, all throughout the day.  We have learned that this is just our new way of life and our way to play with our sweet TY TY!  If I look back at when we started Play Project, I can remember how completely lost I was.  I had no idea how to PULL Tyler out of his world...and then through Play Project I have learned that I don't need or want to pull him out of his world ... I want to enter into his! I am so grateful for Play Project and for Joy, teaching me how to play with my son. Tyler now gives us eye contact on a regular basis, he shows me what he wants with either picture exchange or by pulling my hand, and he is now responding to his name!  Another thing that Play Project has helped us with is his meltdowns, Tyler used to hit his head on walls with frustration, he has not done that for over 1 year! The more we PLAY the better he does! I love Play Project!”

~Rachael

“My Name is Rachael, I have a 4 year old Autistic son named Tyler. I started doing Play Project two years ago with Joy.  Play Project for me has been a new life, a new life style, and a necessity in our lives.  Before we started working with Tyler on Play Project we could not get him to respond to his name, show us what he wanted, or even calm him down.  Play Project is something that I work on each and every day, all throughout the day.  We have learned that this is just our new way of life and our way to play with our sweet TY TY!  If I look back at when we started Play Project, I can remember how completely lost I was.  I had no idea how to PULL Tyler out of his world...and then through Play Project I have learned that I don't need or want to pull him out of his world ... I want to enter into his! I am so grateful for Play Project and for Joy, teaching me how to play with my son. Tyler now gives us eye contact on a regular basis, he shows me what he wants with either picture exchange or by pulling my hand, and he is now responding to his name!  Another thing that Play Project has helped us with is his meltdowns, Tyler used to hit his head on walls with frustration, he has not done that for over 1 year! The more we PLAY the better he does! I love Play Project!”

~Rachael

Eye Contact

It's really quite amazing how much we use our eyes to communicate.  We can know if someone is happy, sad, annoyed, tired, mad, etc. all by looking into someone's eyes.  We can point with our eyes, we can show interest in something (or someone), we can say "come here", we can say "help", we can say a lot with just a tiny movement of our eyes.  Our eyes are not only used to be able to see the amazing things in our world, but also to express how we are feeling about our world.

There are many individuals with autism who lack eye contact.  It can be difficult for those trying to communicate with these individuals, and they may feel that they are being ignored or that the individual is not paying attention or is distracted.  That's usually what we would think if someone is not looking at us when we are speaking to them.  There may be various reasons why someone with autism may not give eye contact, but it's not always because they're ignoring you.

So, the question is...should we force eye contact?  Should we focus on making a child give us eye contact when we're talking to them?  There may be some that disagree with me, and that's fine, but my answer would be no.  The eye contact is not the underlying issue, communication generally is.

I'm not talking about speech here, I'm not talking about being able to form words with our mouths, I'm talking about back and forth interactions, gestural communication.  

As we focus on those back and forth interactions, you will usually find that eye contact improves.  I'm not saying it's going to be perfect, but it will generally increase.  As a child starts to find you more interesting, realizes that their actions and words have power, and that they want to see your reactions, you'll see that they will look to you more often.

Need some ideas on where to start?  There are a lot of place you can start, but here's just one idea.  Try interacting using sensory motor activities.  Activities/toys that involve a lot of visual stimulation can be very difficult to compete against, you want to make the environment a place where YOU are more exciting than the flashy toys around you.

Here are 10 sensory-motor activities you can try starting with

• wrestling
• jumping together (on the trampoline, couch, bed, where ever)
• burrito wrap - get a large blanket, roll the child up, then start adding "topping" and give him/her a lot of deep pressure, then "eat" him/her up.
• bury him/her with pillows
• throw him/her onto the couch and wait for him/her to ask for more
• chase
• build a tower of pillows and run together and knock it down
• play stop and go while you spin him/her on an office chair
• swing him/her in a blanket
• crawl through a tunnel (this blocks out other distractions and they can look at you at the end of the tunnel as they crawl towards you)

Find an activity that your child will want more of. Play, play, play, and then pull back a little to see if your child will initiate more.  Don't force him/her to say more, watch their gestures and take them as cues.  Don't discount gestural communication, it's the beginning of communication skills and it's part of the foundation that they need to strengthen.

Joy Mano

Utah P.L.A.Y. Project Home Consultant

Early Childhood Autism Intervention

It's really quite amazing how much we use our eyes to communicate.  We can know if someone is happy, sad, annoyed, tired, mad, etc. all by looking into someone's eyes.  We can point with our eyes, we can show interest in something (or someone), we can say "come here", we can say "help", we can say a lot with just a tiny movement of our eyes.  Our eyes are not only used to be able to see the amazing things in our world, but also to express how we are feeling about our world.

There are many individuals with autism who lack eye contact.  It can be difficult for those trying to communicate with these individuals, and they may feel that they are being ignored or that the individual is not paying attention or is distracted.  That's usually what we would think if someone is not looking at us when we are speaking to them.  There may be various reasons why someone with autism may not give eye contact, but it's not always because they're ignoring you.

So, the question is...should we force eye contact?  Should we focus on making a child give us eye contact when we're talking to them?  There may be some that disagree with me, and that's fine, but my answer would be no.  The eye contact is not the underlying issue, communication generally is.

I'm not talking about speech here, I'm not talking about being able to form words with our mouths, I'm talking about back and forth interactions, gestural communication.  

As we focus on those back and forth interactions, you will usually find that eye contact improves.  I'm not saying it's going to be perfect, but it will generally increase.  As a child starts to find you more interesting, realizes that their actions and words have power, and that they want to see your reactions, you'll see that they will look to you more often.

Need some ideas on where to start?  There are a lot of place you can start, but here's just one idea.  Try interacting using sensory motor activities.  Activities/toys that involve a lot of visual stimulation can be very difficult to compete against, you want to make the environment a place where YOU are more exciting than the flashy toys around you.

Here are 10 sensory-motor activities you can try starting with

• wrestling
• jumping together (on the trampoline, couch, bed, where ever)
• burrito wrap - get a large blanket, roll the child up, then start adding "topping" and give him/her a lot of deep pressure, then "eat" him/her up.
• bury him/her with pillows
• throw him/her onto the couch and wait for him/her to ask for more
• chase
• build a tower of pillows and run together and knock it down
• play stop and go while you spin him/her on an office chair
• swing him/her in a blanket
• crawl through a tunnel (this blocks out other distractions and they can look at you at the end of the tunnel as they crawl towards you)

Find an activity that your child will want more of. Play, play, play, and then pull back a little to see if your child will initiate more.  Don't force him/her to say more, watch their gestures and take them as cues.  Don't discount gestural communication, it's the beginning of communication skills and it's part of the foundation that they need to strengthen.

Joy Mano

Utah P.L.A.Y. Project Home Consultant

Early Childhood Autism Intervention