Doctors Office Intervention for Kids With Autism


We all know that visits to the doctors office can be difficult, I addressed some of those reasons in my post about sensory overload and the doctor's office.  Today I want to share an experience that one of my student's parents told me about their visit to the doctor.  We'll call this child John.

John hated going to the doctor, it just wasn't a pleasant experience for him or anyone that went with him.  John's mom said that usually both of them would leave the doctor's office crying, it was just a horrible experience.  That changed.

Here's what they changed at their doctor's office.

  • First, John's doctor sent him a story which included pictures of the doctor's office and a play by play story of what would be happening.  It also included pictures of the nurses and the doctor that he would be visiting.  John's mom read this story with him several times before his visit to the doctor.
  • Next, John's mom was allowed to check in as they were driving to the doctor's office.
  • Since they already checked in, when they arrived to the doctor's office, there was no waiting.  They immediately took John back.
  • Prior to the visit, John's mom filled out a questionnaire that included what John's high interest was.  John's favorite toys were Toy Story toys.
  • The nurses used Buzz and Woody to help John with transitions.
  • John used to get very upset when he had to be weighed, but this time the nurse showed John how Woody was going to be weighed first.  She narrated what was going on, so when it was John's turn, he was excited to get weighed and did it without a problem.
  • Once John got to the room he was assigned to, there was no waiting!
  • John's nurses and doctor basically used PLAY to make John feel comfortable, and to help him to follow directions.  John's mom said it was amazing.
  • The best part was that both John and his mom were able to leave the doctor's office without a tear :)
I was so impressed with this doctor, and I wish that more people could implement some of these simple techniques in order to help more children have successful experiences out in the community.

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

Show And Tell -- Tip Tip Dig Dig

Happy Show And Tell Day!

First off, I love Emma Garcia's books.  They're so much fun.  One of the reasons I fell in love with her books is because my students loved them so much.  Many of my students who didn't usually participate in circle time would imitate all the actions for this book.  It's so simple, it has good repetitive lines the kids could repeat, and nice action words that could be acted out.

A lot of kids with autism love cars or trucks, so this Tip Tip Dig Dig is kind of perfect as far as an attention getter.  If you are working on imitation skills, this book is motivating.  If you are working on actions words, it's also a good one.

A couple other Emma Garcia books that I love are Toot Toot Beep Beep, and Tap Tap Bang Bang.  Check them out!

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

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

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


photo credit: Joe Shlabotnik via photopin cc

Show and Tell: 10 Little Bumblebees


It's Friday!!!  That means I get to share one of my favorite things.  This week I want to share with you one of my favorite circle time songs.

I think one of the reasons I like this song so much is because I love the props my staff helped me make. They're so cute, and so easy to make!

What you need: black gloves, yellow duct tape

As you can tell from the picture we just took strips of tape and put them around the fingers.  We also made cute little antennas, but if I were doing it again, I would just forego that part.  Most of them were either ripped off or chewed off.

Why I love this song and the props, in no particular order :)

  • We're learning about numbers
  • Putting on gloves is good fine motor work
  • Getting tactile input from the soft gloves
  • Learning to tolerate gloves for the winter season
  • Kids ask for help when they need it
  • Finger isolation when singing the song
  • Imitation skills
  • Proprioceptive input with tickling.  I like to tickle when the bees are buzzing all around
  • Kids share as we have one or two students pass out the gloves
  • Clean up, learning to put things away and waiting a turn to put their props back int he box
  • Attending.  Music is always a great motivator for attending and staying seated
For some reason Amazon isn't letting me add anything to my Astore today, but I'll add this song to my Amazon Favorites when I get a chance.  For now, here's a link to a sample of the song.  10 Little Bumblebees.

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

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

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

Show and Tell -- Duck Duck Moose Apps


If you haven't tried the Duck Duck Moose Apps, you really should.  They are great for kids.  With familiar tunes, great animations, and interactive activities how could you go wrong?

Here's more reasons why I love the Duck Duck Moose Apps.

  • Great cause and effect applications
  • Counting games
  • A lot of actions that you can talk about with your child while he's playing.  "Hey! You made him jump!" "He's climbing his web."  Etc.
  • You can sing with it, or sing alone with the accompaniment
  • You can record your child singing it
  • Kids love it and stay engaged with the learning activities
Try some out if you haven't already.  They are between $0.99 and $1.99.