Everyday Interventions for Young Children with Autism

A practical guide packed with simple, highly effective suggestions for promoting the development of children birth to 3 with red flags for autism.

https://bpub.fyi/AutismInterED

Learning Objectives

• Learn about the presenters’ model of the core deficits of autism
• Discover which skills are associated with the four components of the model (social communication, flexibility, regulation, and making sense of self, others, and the environment)
• Understand the relationship between the components of the model
• Come away with effective new strategies for facilitating skills within daily routines, such as mealtime, bath time, and playtime

DSM-5

Persistent deficits in social communication and social interaction across multiple contexts:

• Deficits in social-emotional reciprocity (SC)
• Deficits in nonverbal communicative behaviors used for social interaction (SC)
• Deficits in developing, maintaining, and understanding relationships (SC, MSSOE)

Restricted, repetitive patterns of behavior, interests, or activities:

• Stereotyped or repetitive motor movements, use of objects, or speech (SC, MSSOE, F)
• Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (F)
• Highly restricted, fixated interests that are abnormal in intensity or focus (F, SC, MSSOE)
• Hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment (MSSOE)

Building Skills to Support Making Sense of Self, Others, and the Environment

• Attends to Sensory Stimuli
• Tolerates Sensory Stimuli
• Shifts Attention
• Imitates Actions
• Follows Directions

Example of Routine in which Attends to Sensory Stimuli Is Embedded

Bath Time:

• Auditory: Talk about body parts being washed, the warm water, and the bath toys. Make up a song about washing.
• Olfactory: Use a variety of scented bath products.
• Tactile/Proprioceptive: Vary the pressure when washing and drying. Provide a massage after bath.
• Visual: Provide a variety of colored containers to fill and dump. Use bubble bath or tablets to change the color of the water. Blow bubbles near the child.

Example of Routine in which Tolerates Sensory Stimuli Is Embedded

Community Outings:

• Auditory: Describe sounds the child will hear such as an approaching siren or train.
• Gustatory: Provide tastes of new foods when going out to eat. (Some children are more willing to try foods at a restaurant.)
• Olfactory: If walking by something that has an unpleasant smell, playfully say “yuck, that stinks!”
• Proprioceptive: Help the child jump over cracks in the sidewalk.
• Vestibular: For children who don’t like to swing, as a first step, put the child on your lap and sit on the swing without moving it.

Example of Routine in which Shifts Attention Is Embedded

Diapering and Dressing:

• Show the child an item used in the diapering routine such as the clean diaper or the wipes and name them. If the child doesn’t look at the item, move the item to the child’s visual field and then to your mouth so the child looks at the item and then to you.
• When putting on the child’s socks and shoes, hold out the article of clothing and wait for the child to extend each foot. If the child does not do so, tap on his or her foot.
• Help the child shift attention to your voice by being playful and building anticipation such as “I’m going to….. kiss your nose.”

Example of Routine in which Imitates Actions Is Embedded

Bedtime:

• Blowing kisses
• Hugging stuffed animals
• Folding hands for prayers

Example of Routine in which Following Directions Is Embedded

Book Time:

• “Get the bunny book.”
• “Turn the page.”
• “Touch the apple.”
• “Put the book away.”

Flexibility: What is It?

Example of Routine in which Flexibility is Embedded

Community Outings:

• Vary the route taken when walking around the neighborhood.
• Vary walking and riding in a stroller or wagon.
• Vary the songs sung and videos watched when in the car.
• Vary who pushes the cart and the type of cart used in the store.

Building Skills to Support Social Communication

• Looks into others’ eyes
• Imitates gestures, sounds and words
• Uses gestures for a variety of functions
• Uses words for a variety of functions
• Participates in multiple exchanges with gestures and/or words

Example of Routine in which Looks into Others’ Eyes Is Embedded

Bath Time/Dressing and Diapering:

• Play Peekaboo with a towel, clean diaper or the child’s clothing.
• Use predictable language and sensory-social games the child likes such as “I’m gonna tickle your belly…”
• When dressing the child, position him or her so he or she can easily see your face.

Communication skills: Gestures

Example of Routine in which Imitates Gestures, Sounds and Words Is Embedded

Household Activities:

• Wiping highchair tray: also provide a cloth for the child and as you wipe, say “wipe, wipe, wipe.”
• Watering the garden: model the sound of water running as you water and then hand the child the hose.

Example of Routine in which Uses Gestures For a Variety of Functions Is Embedded

Playtime:

• Place some desired toys out of reach to encourage reaching or pointing to request.
• Embed gestures into pretend play such as those to represent sleeping, eating and drinking.

Example of Routine in which Uses Words For a Variety of Functions Is Embedded

Grooming and Hygiene:

• When brushing the child’s hair or teeth, sing a song and pause for the child to fill in words such as “This is the way we brush your ____.”
• Ask “Now what?” when the child knows what comes next in the sequence.

Example of Routine in which Participates in Multiple Exchanges with Gestures and/or Words Is Embedded

Bedtime:

• Talk about events of the day that were fun for the child.
• Ask relevant questions and comment about the child’s statements.

Building Skills to Support Regulation

• Determine the influences of Making Sense of Self, Others, and the Environment, Flexibility, and Social Communication
• Help families and caregivers with strategies to prevent dysregulation
• Help families and caregivers with strategies to regain regulation

Example of Routine in Which Dysregulation May Occur: Possible Reasons

Mealtime/Snack Time:

• Making Sense of Self, Others, and the Environment: Child may not recognize thirst or hunger or may not like the feel of the bib or the straps on the highchair.
• Flexibility: Child may only want to eat foods of a certain color or only want a specific person to feed him or her.
• Social Communication: Child may not be able to communicate likes and dislikes regarding food or its presentation.

Preventing Dysregulation

• Be clear what is a choice and what is a direction. Avoid “can you,” “will you,” “do you want to” if a direction.
• Tell the child what to do rather than what not to do.
• Count to ten for turn taking and disliked routines such as wiping the face.
• When possible, give two alternatives when a child can’t have something.
• Use a visual strategy such as an X to signify something is not available.
• During transitions, say “bye bye” or “all done _____” and when appropriate, focus on what is next rather than what the child is leaving.
• Use prompts and systematically fade them.
• During challenging routines, use small steps and use potent reinforcers.

Prompting

• Hierarchies include physical prompts, visual prompts, models, or verbal prompts
• Most to least: for new goal
• Least to most: for practice

Most-to-Least Prompting

Example Scenario: When finished drinking, Laurie will independently walk over to the table and place her cup on it.

1. Mom walks Laurie over to the table and guides Laurie’s hand to place the cup on the table.
2. Mom tells Laurie to put her cup on the table.
3. Mom asks Laurie, “Where does your cup go?”
4. Mom says “table.”
5. Mom points to the table.

Least-to-Most Prompt Hierarchy

Example Scenario: Laurie will indicate by gesturing, rather than by throwing her food or screaming, that she wants to get down from her booster seat.

1. Mom looks expectantly at Laurie and shrugs as if she is asking a question.
2. Mom asks Laurie, “What do you want?”
3. Mom asks Laurie “Do you want down?”
4. Mom says, “Tell me down.”
5. Mom models by pointing down.
6. Mom takes Laurie’s hand and helps her point down.

Merle’s And Barb’s Staples For The Recipe For Success

• Begin with engagement and regulation as they are necessary for learning.
• Consider the function and the developmental appropriateness of challenging behavior when determining the consequence.
• When targeting communication, consider modalities and vocabulary that will be powerful in a variety of settings.
• Use the sequence of development as a framework, concentrating on foundation skills, filling in gaps when there are splinter skills, and using knowledge of ASD to guide outcomes and strategies.

Staples, Continued

• Embed learning in multiple routines across the day considering what is functional and practical.
• Collaborate with all team members to ensure everyone is "on the same page" as much as possible.
• Choose meaningful and practical ways to measure progress.
• Plan for generalization by varying the people, the setting, the materials, the words, and the prompts while always being cognizant of fading.

Thank you!