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

Theory of Mind and Autism

photo credit: Olaf_S via photopin cc

When I was first learning about Theory of Mind, I was told a little scenario to help me understand.  It went something like this.

Two children are in a room with an adult.  The adult puts a teddy bear in a red box.  Child 1 leaves the room.  Child 2 watches the adult move the teddy bear from the red box to a green box.  Where will Child 1 think the teddy bear is?

A young child (usually 0-3 yrs old) will say that Child 1 will think that the bear is in the green box because they know that's where it is.  A child who has developed theory of mind will know that Child 1 will still think that the bear is in the red box because Child 1 did not see the adult move the bear.

Children with autism, oftentimes have a very difficult time with Theory of Mind.  This is one of the reasons that participating in pretend play, and talking about emotions and feelings is important for children.  However, developmentally, a child needs to be ready to participate in pretend play...trying to get a child to participate in pretend when they are not at that functional developmental level yet,  will not be beneficial.

Here is an article that I enjoyed about Theory of Mind.

Joy Mano
Utah P.L.A.Y. Project Home Consultant
Early Intervention Treatment for Children With Autism

photo credit: Olaf_S via photopin cc

When I was first learning about Theory of Mind, I was told a little scenario to help me understand.  It went something like this.

Two children are in a room with an adult.  The adult puts a teddy bear in a red box.  Child 1 leaves the room.  Child 2 watches the adult move the teddy bear from the red box to a green box.  Where will Child 1 think the teddy bear is?

A young child (usually 0-3 yrs old) will say that Child 1 will think that the bear is in the green box because they know that's where it is.  A child who has developed theory of mind will know that Child 1 will still think that the bear is in the red box because Child 1 did not see the adult move the bear.

Children with autism, oftentimes have a very difficult time with Theory of Mind.  This is one of the reasons that participating in pretend play, and talking about emotions and feelings is important for children.  However, developmentally, a child needs to be ready to participate in pretend play...trying to get a child to participate in pretend when they are not at that functional developmental level yet,  will not be beneficial.

Here is an article that I enjoyed about Theory of Mind.

Joy Mano
Utah P.L.A.Y. Project Home Consultant
Early Intervention Treatment for Children With Autism

Autism and "The Stare"

photo credit: tbone_sandwich via photopin cc

Let's talk about "the stare" for a second.  I'm not talking about a stare you might receive from a child with autism, I'm talking about a stare you might find someone giving someone else when their child is acting out in public.

Here's some food for thought:

• A child with autism has the same physical features as a child without autism.
• If a child with autism is approached the same way that a child without autism is approached when they are having a meltdown, the opposite reaction of what is expected may take place.  (This could be why a parent is not doing what one may think they should be doing.) 
• Autism is NOT and never has been caused by bad parenting.
• Giving a child the opportunity to have new experiences in various environments is important in that child's development, even if it ends up in a meltdown.
• Most people are able to go to the store without the constant fear of something going wrong, and most people take it for granted.  
• The majority of communication is done through body language.  "The stare" can be judgmental and demoralizing.  The definition of demoralizing is to deprive a person of spirit and courage...to destroy morale.

I recognize that there are other instances (besides meltdowns) when families receive the unwarranted "stare" and I will address that in a future post.  The purpose of this post is for all of us to take a step back and check ourselves.  Ask yourself if you've ever found yourself giving "the stare" and then ask yourself how you would want people to react if you swapped places.

Joy Mano

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

Early Intervention for Children with Autism

photo credit: tbone_sandwich via photopin cc

Let's talk about "the stare" for a second.  I'm not talking about a stare you might receive from a child with autism, I'm talking about a stare you might find someone giving someone else when their child is acting out in public.

Here's some food for thought:

• A child with autism has the same physical features as a child without autism.
• If a child with autism is approached the same way that a child without autism is approached when they are having a meltdown, the opposite reaction of what is expected may take place.  (This could be why a parent is not doing what one may think they should be doing.) 
• Autism is NOT and never has been caused by bad parenting.
• Giving a child the opportunity to have new experiences in various environments is important in that child's development, even if it ends up in a meltdown.
• Most people are able to go to the store without the constant fear of something going wrong, and most people take it for granted.  
• The majority of communication is done through body language.  "The stare" can be judgmental and demoralizing.  The definition of demoralizing is to deprive a person of spirit and courage...to destroy morale.

I recognize that there are other instances (besides meltdowns) when families receive the unwarranted "stare" and I will address that in a future post.  The purpose of this post is for all of us to take a step back and check ourselves.  Ask yourself if you've ever found yourself giving "the stare" and then ask yourself how you would want people to react if you swapped places.

Joy Mano

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

Early Intervention for Children with Autism

How autism was explained to me

The first time I remember learning about Autism was when I was working at a summer camp for people with disabilities in Salt Lake City, Utah.  We were preparing for a week when several of the kids coming had autism.  They had someone come in to talk to us counselors about autism.  At this point in my life, I had already been working with people with various developmental disabilities, but none of the people I had worked with had autism.

I don't remember the name of the lady who came to talk to us, but I remember one of her explanations of autism.  This was back in 2004.

It went something like this:

Imagine you are in a foreign country, maybe Russia or something like that.  You're going along minding your own business when suddenly all these people start coming towards you.  They're saying something and they look upset but you don't understand them.  They start raising their voices as if that will help you understand what they're saying, but you don't speak their language.  They start waving their arms, and you can tell they're upset, but you still don't know why.  How are you supposed to fix it when you don't know what happened?  So, what do you do?  Fight or flight.  You may curl up in a ball, hiding your face from them.  You may plug your ears to tune them out.  You may start screaming back at them in your own language.  You may try to run away.  You may start doing something to help yourself calm down.    We all react in different ways.

You can see how this situation may be a bit frightening, uncomfortable, and intimidating.  She went on to explain that this may be how some of these kiddos are feeling.  Sometimes they don't understand our language, or our culture.  We may get upset because they did something that according to us was not right, but they may not understand why.  And sometimes even when we are explaining it to them, we are not speaking the same language and they still don't understand.  When they become overwhelmed and frightened, they may start doing things like plugging their ears, screaming, running away, rocking, looking away, etc.

When she told us this scenario, my eyes were opened.  I felt like this didn't just apply to autism, but to a lot of situations.  It put me in a situation that I could imagine myself in, and it made me have more empathy for all the people I had ever worked with and would work with.  As Temple Grandin said in her presentation the other week, her "fear center" is 3 times as big as is expected in a brain.  Can you imagine how certain situations that may seem "normal" to us can be very frightening for someone with autism?

I don't know how accurate this little story is, but I'm grateful for it because it changed me early in my career as how to approach various situations and how to have more empathy for those reacting differently than I would to those situations.

Joy Mano
Utah P.L.A.Y. Project Home Consultant
Early Childhood Autism Intervention

 photo credit: massdistraction via photopin cc

The first time I remember learning about Autism was when I was working at a summer camp for people with disabilities in Salt Lake City, Utah.  We were preparing for a week when several of the kids coming had autism.  They had someone come in to talk to us counselors about autism.  At this point in my life, I had already been working with people with various developmental disabilities, but none of the people I had worked with had autism.

I don't remember the name of the lady who came to talk to us, but I remember one of her explanations of autism.  This was back in 2004.

It went something like this:

Imagine you are in a foreign country, maybe Russia or something like that.  You're going along minding your own business when suddenly all these people start coming towards you.  They're saying something and they look upset but you don't understand them.  They start raising their voices as if that will help you understand what they're saying, but you don't speak their language.  They start waving their arms, and you can tell they're upset, but you still don't know why.  How are you supposed to fix it when you don't know what happened?  So, what do you do?  Fight or flight.  You may curl up in a ball, hiding your face from them.  You may plug your ears to tune them out.  You may start screaming back at them in your own language.  You may try to run away.  You may start doing something to help yourself calm down.    We all react in different ways.

You can see how this situation may be a bit frightening, uncomfortable, and intimidating.  She went on to explain that this may be how some of these kiddos are feeling.  Sometimes they don't understand our language, or our culture.  We may get upset because they did something that according to us was not right, but they may not understand why.  And sometimes even when we are explaining it to them, we are not speaking the same language and they still don't understand.  When they become overwhelmed and frightened, they may start doing things like plugging their ears, screaming, running away, rocking, looking away, etc.

When she told us this scenario, my eyes were opened.  I felt like this didn't just apply to autism, but to a lot of situations.  It put me in a situation that I could imagine myself in, and it made me have more empathy for all the people I had ever worked with and would work with.  As Temple Grandin said in her presentation the other week, her "fear center" is 3 times as big as is expected in a brain.  Can you imagine how certain situations that may seem "normal" to us can be very frightening for someone with autism?

I don't know how accurate this little story is, but I'm grateful for it because it changed me early in my career as how to approach various situations and how to have more empathy for those reacting differently than I would to those situations.

Joy Mano
Utah P.L.A.Y. Project Home Consultant
Early Childhood Autism Intervention

 photo credit: massdistraction via photopin cc

Hope

Jed Baker, PhD, the author of No More Meltdowns, and Social Skills Picture Book came and presented with Temple Grandin at the Utah Autism and Aspberger's Conference last week.  I really enjoyed his presentation on behavior and social skills.  He has great ideas, and you can tell he has made a big impact on many lives through the people he has worked with one on one and also through his presentations to parents and professionals.

One of the main themes of his presentation was HOPE.  Why do we do what we do? Hope.  How is it that we get through the hard times and we endure the challenging behaviors?  Hope.  We may work and work and work with a child whether they are a student or your own child, we will continue to find ways to work with that child because we have HOPE that what we are doing is making a difference for that child, and that's what makes everything worth it.

There was so much information in this presentation that I won't be able to convey it all right now, so I'm just going to point out one other thing he talked about.  He said "90% of teaching and parenting is tolerance."  We have to be able to "tolerate our own discomfort long enough to think about what to do."  "The individual's behavior is not intended to simply challenge your authority, but is rather a reflection of his/her lack of coping skills."  He went on to say that "our responsibility is to teach a child coping skills, not to establish a hierarchy."

Dr. Baker also talked about the 20/80 rule.  80% of kids, your average rules and consequences will work.  However, it's those 20% of kids that you need to re-evaluate what you're doing and change your interventions accordingly.

Something else that I think is very important is trust.  Dr. Baker said, "It is very hard to impact another human being without trust."  This where we always need to start.  Every relationship should start with trust.

Here is a list of Jed Baker's books
Social Skills picture books
Social skills training for children and adolescents with Aspbergers syndrome 
Preparing for life
The social skills picture book for high school and beyond
No more meltdowns

Here his DVD

Social skills training and frustration management

Joy Mano

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

Early Childhood Autism Intervention

Jed Baker, PhD, the author of No More Meltdowns, and Social Skills Picture Book came and presented with Temple Grandin at the Utah Autism and Aspberger's Conference last week.  I really enjoyed his presentation on behavior and social skills.  He has great ideas, and you can tell he has made a big impact on many lives through the people he has worked with one on one and also through his presentations to parents and professionals.

One of the main themes of his presentation was HOPE.  Why do we do what we do? Hope.  How is it that we get through the hard times and we endure the challenging behaviors?  Hope.  We may work and work and work with a child whether they are a student or your own child, we will continue to find ways to work with that child because we have HOPE that what we are doing is making a difference for that child, and that's what makes everything worth it.

There was so much information in this presentation that I won't be able to convey it all right now, so I'm just going to point out one other thing he talked about.  He said "90% of teaching and parenting is tolerance."  We have to be able to "tolerate our own discomfort long enough to think about what to do."  "The individual's behavior is not intended to simply challenge your authority, but is rather a reflection of his/her lack of coping skills."  He went on to say that "our responsibility is to teach a child coping skills, not to establish a hierarchy."

Dr. Baker also talked about the 20/80 rule.  80% of kids, your average rules and consequences will work.  However, it's those 20% of kids that you need to re-evaluate what you're doing and change your interventions accordingly.

Something else that I think is very important is trust.  Dr. Baker said, "It is very hard to impact another human being without trust."  This where we always need to start.  Every relationship should start with trust.

Here is a list of Jed Baker's books
Social Skills picture books
Social skills training for children and adolescents with Aspbergers syndrome 
Preparing for life
The social skills picture book for high school and beyond
No more meltdowns

Here his DVD

Social skills training and frustration management

Joy Mano

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

Early Childhood Autism Intervention