Category Archives: Early Intervention

Going to the Dentist

Taking your child to the dentist can be an ordeal, especially for the first few times, since they are expected to let a strange person put cold metal tools into their mouths and sit still during the whole visit. For a child on the spectrum, this ordeal can be especially challenging for the family as well as the dentist. For Nicole Brown and her daughter Camryn, going to the dentist for a basic cleaning was a miserable experience. Camryn was confused and disoriented by the bright lights in her face, the strange noises the dentist’s tools made, and everything else unfamiliar in the room. She would sometimes panic and run out of the office altogether.

Ms. Brown was finally able to locate a pediatric dentist that was able to help her daughter adjust to her routine visits. Instead of suggesting that her child be sedated with anesthetics or immobilized, Dr. Luedemann-Lazar set up weekly visits to help ease Camryn to the norms of seeing the dentist. She gave her lots of breaks so that she wouldn’t get overwhelmed as well as gave incentives, with the help of mom, such as listening to a snippet of her favorite song when she sat calmly for a bit.

Now, researchers are studying how to help children on the spectrum overcome any challenges and fears they have when visiting the dentist. New programs are also being implemented to help dentists and their staff learn more about treating children with special needs. Josalyn Sewell, a dental hygienist with an autistic son, says, “There are children who are completely nonverbal, and if they have a toothache, it completely shuts them down.” This is why parents are urged to start dental care before there is an actual emergency, such as a toothache or cavity, because putting a distressed child in an unfamiliar situation never goes smoothly.

Here are some tips to help your child adjust to dental hygiene and dentist visits:

  • Start Early: get your child familiar with the brushing sensation on gums before their first teeth even come in, so that when your child is ready for the toothbrush they are used to the process and sensations that come with brushing your teeth.
  • Go Electric: since many children, including those not on the spectrum, have very little patience when it comes to brushing their teeth, an electric toothbrush can help parents make the most of the time they are able to actually brush their child’s teeth.
  • Start Small: if getting the brush in your child’s mouth is a major obstacle, then start with baby steps; maybe brush one tooth first for a few seconds and then two or three days later, try brushing the same tooth again for a few more seconds. It’s always okay to take it slow.
  • Rewards: some parents call it bribery, others call it incentives, whatever the case, introducing a small reward every time your child is able to keep the brush in their mouth or even allows the brush in their mouth can go a long way–just make sure the reward isn’t candy.
  • Set up the routine:  let your child know what is going to happen. This can be done through visual aides such as creating a picture schedule to supplement the words used to describe what will happen.
  • Careful with toothpaste: use kid-friendly toothpaste kids, especially those still learning how to spit, and even so, only use a very small amount. Sometimes a wall-mounted toothpaste dispenser can be helpful for kids learning to handle toothpaste portions on their toothbrush.
  • Set a timer: brushing until the count of ten, or to the end of a song, or setting a timer to let the child know how long they should brush for and when the brushing is okay to stop makes this activity much more manageable for both parent and child.

To read the original articles, click HERE and HERE

 



Earlier Autism Detection Raises Questions About Early Intervention

Autism is a genetic disorder that affects about 20% of younger siblings of those on the spectrum. Researchers are now saying that they often show symptoms as early as 18 months, according to a study published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). The study used 719 younger siblings of those with autism, otherwise known as ‘high risk’ siblings, who were assessed at 18 months and then 36 months to identify any social, communications, and repetitive behaviors that could be early symptoms. Warning signs such as poor eye contact and/or repetitive behaviors were observed in 57% of siblings and among those without symptoms at 18 months, for the ones who were later diagnosed, started showing signs by 36 months. Researchers note that about half of the children had poor eye contact combined with limited gestures and imaginative play while other children exhibited repetitive behaviors and lacked nonverbal communication skills.

Although it is important to detect these warning signs or early symptoms of autism, John Elder Robison, author of Raising Cubby, Look Me in the Eye, My Life with Asperger’s and Be Different–adventures of a free range Aspergian, and member of the Interagency Autism Coordinating Committee of the US Dept. of Health and Human Services, expresses his concern over early intervention. According to people on the spectrum who had received early intervention treatments as children, their experiences seemed half positive and half negative.

While many people talk about how wonderful it was to have that support throughout their childhood, “others talk about suppressing behaviors that embarrassed parents…[and] imposing their will where it was not wanted.” Robison argues that this is something to take into serious consideration as we move forward with creating new treatments and therapies for early intervention. He critiques our abilities to deter autism in infants now as young as 6 months old, asking what interventions are actually appropriate at this stage and to what end?

When providing intervention for a four-year-old, we are able to see the progress we make in the child’s behaviors and adjust our plans accordingly. However, with an infant, the issues are not very clear, Robison says, “We may pick up a sign of autism, but what kind of autism? Will the child be verbal or silent? Will the child be lovable, eccentric, unable to care for themselves or talk…it’s too early to know.”

As we continue to move forward with autism diagnoses at earlier stages, we also need to move forward in the methods and treatments we use for early intervention.

To read the original study, click HERE

To read John Elder Robison’s article, click HERE



Taking Literacy to the Next Level



Dr. Marion Blank is a developmental psychologist with a specialization in language and learning, director of the A Light on Literacy Program in the Department of Child Psychiatry at Columbia University, and a consultant to government bureaus in England, Canada, Holland, Israel, and Australia. After studying how children learn language for over 40 years, she received the Upton Sinclair Award in Education. For children on the spectrum, about half are non-verbal or are limited to few words. So when we see news stories like the one about the non-verbal autistic teen who gave a graduation speech using technology, we think of them not only as an extraordinary individual but also as an isolated case that goes against the norm.

Dr. Blank uses this point to criticize the assumption we make that children who are non-verbal will not be able to use language. She asks, “what if most, if not all non-verbal children could learn to read and write and are not doing so simply because they have not been taught?” For typically developing children, spoken language comes before written language, so if they cannot speak then they are not ready for reading and writing. For these students on the spectrum, their school instruction focuses on learning to write their name, learning signs relevant to the classroom, and learning a few sight words; but they are not given the same opportunities as those that we hear about on the news.

Is it possible that all non-verbal children are able to learn language to the extent of these “isolated cases”? Dr. Blank argues that is it because its important to recognize that many of the success stories we see on the news actually started with a lot of home instruction. They were able to find the methods that fit their child’s needs in order to teach them in a way that allowed them to learn. “They [parents] also did not use traditional reading instruction and so were able to transcend the assumptions guiding the educational system and use technology to give their children the opportunity to become competent language users,” she says. This is why she designed her own program the mimic this type of home instruction, called Reading Kingdom.

Overall, it is important for parents, professionals, and the general public to understand that non-verbal autistic individuals are definitely capable of more than we usually assume. Dr. Blank says we know we succeeded when we no longer see these success stories on the news because literacy in children on the spectrum will be the norm.

To read the original article, click HERE



Understanding Sensory Challenges

Occupational therapist Lindsey Biel, co-author of “Raising a Sensory Smart Child” and “The Definitive Handbook for Helping Your Child with Sensory Processing Issues,” has some important points to make about how to best support a child with sensory issues. As the number of children with autism rises, so does the concern in the autism community for providing the necessary knowledge to understand those affected by sensory overload.

Inspired by Temple Grandin’s book, “Thinking in Pictures,” Biel became facinated with people who see the world in a unique perspective. She explains the importance of educating others about sensory challenges, stemming from her own struggles as a child with issues such as discomfort in fluorescent lighting and noise in the cafeteria. Her first two books were geared towards giving parents and professionals best practices that were usually only implemented during a therapy session or within the school. Her new book “Processing Challenges: Effective Clinical Work with Kids & Teens” is more geared towards professionals in the autism field–psychologists, therapists, social workers, etc. Many times sensory problems are not recognized as the problem and the connection between the sensory challenge and the behavior gets lost. Biel pushes the idea that we need to start to really listen to what people with sensory issues have to say. In order to make a difference in these people’s lives, we need to:

  • Collaborate with individuals who experience the world and their bodies differently and work together
  • Empower people with sensory problems to become  more self aware to self-advocate
  • Share ideas, perspectives in magazine articles both in general parenting and other general consumer publications as well as autism specific publications
  • Speak to parenting groups and have professional workshops, including staff development around these issues

She argues, “There is still so much research, education, and awareness that needs to happen. We still ask students and workers to adjust to schools and workplaces rather than adjusting those environments to meet the need of the user. Parents still have pediatricians who trivialize their concerns about oversensitivities to noise, or clothing fabrics, smells, and so on. And they still have friends and relatives who think they’re indulging their child when they give them movement breaks or special allowances to accommodate their sensory needs…Every parent, teacher, and caregiver needs to know first and foremost that when a person is at the mercy of sensory issues, it can be extraordinarily difficult to behave as expected.”

Some basic tips for caregivers dealing with children on the spectrum are:

  • avoid harsh lighting
  • provide soft and seamless clothing
  • use a reassuring and firm touch
  • speak gently and patiently using clear language that is straightforward and free of unnecessary words 
  • do not demand eye contact when you are speaking
  • understand that they are not going to stop self-stimulatory behaviors just because you tell them to
  • assume competence even if the child/person has yet to prove this to you

Shema Kolainu- Hear Our Voices, offers its students a one-of-a-kind multisensory environment called the Snoezelen room. This room is specially designed to deliver stimuli to various senses using lighting effects, color, sounds, music, and scents. It provides a sense of calm to the child who may be experiencing some form of sensory overload and allows for student and teacher to work on communication, enhance their understanding of each other and build trust. Read more about our state-of-the-art room HERE!

For more resources on handling sensory challenges:

http://sensorysmarts.com/

http://sensoryprocessingchallenges.com/

To read the original interview with Lindsey Biel, click HERE

 



5-Year-Old Raises Awareness

Iris Grace and her cat Thula

Iris Grace is a five year old diagnosed with autism who picked up a paintbrush last year and has been making waves ever since.

“It was her first painting I noticed a difference in her painting compared to how you would normally expect a child to paint. She filled the page with color but with thought and consideration…We did’t think much of it at the time, we were just so happy to have found an activity that brought her so much joy,” Iris’s mom, Arabella Carter-Johnson, explains.

Her paintings have gotten attention and praise all across Europe, Asia, and America. In fact, many have been sold to private collectors for thousands of pounds each. Iris and her family use the profit to pat for art supplies as well as all of her therapies. Even Ashton Kutcher has tweeted about her artwork:

“She will watch water, trees, wind, leaves, flowers, birds, clouds…she is so interested in movement and how it changes things…I can see so much of what fascinates her in her art, I believe she can see things in more detail or notice things in more detail,” says Arabella. By following through on Iris’s interests, they are now also able to raise awareness about the kinds of resources and tools that we need to help children with autism. They even started their own activity club that meets every Saturday to provide support to children on the spectrum.

According to the American Art Therapy Association, art therapy is the process where “art media, the creative process, and the resulting artwork is used to explore feelings, reconcile emotional conflicts, foster self-awareness, manage behavior and additions, develop social skills, improve reality orientation, reduce anxiety, and increase self-esteem. A goal in art therapy is to improve or restore functioning and his/her sense of personal well-being.”

Shema Kolainu offers art therapy as part of their program to help children on the spectrum focus their thoughts and express themselves through mediums other than verbal communication, which can be very challenging for students on the spectrum. Read more about the therapies offered by Shema Kolainu, HERE.

To see more of Iris’s artwork, click HERE



ABA Therapy Continues Its Success

PHOTO: The Rogersons are happy their sons Tom (L) and Jack (R) are close but don't think Tom should be responsible for Jack as he grows older. (ABC: Australian Story)

Jack Rogerson was diagnosed with autism as a toddler and written off by many medical professionals as low-functioning and limited to special education schooling. He was a hyperactive child who could not express affection and could barely speak but his parents believed that with the right tools and support, their son would eventually be able to live independently and engage in all the same activities as his peers.

After meeting Dr. Elizabeth Watson, a speech pathologist and therapist, Jack’s parents learned about Applied Behavior Analysis (ABA) that is used for early childhood intervention for kids on the spectrum. ABA therapy is essentially “a teaching technique that breaks down every skill that a child needs to learn into very small discrete steps, each of which is taught individually with painstaking repetition and they joined together to complete the task. It is applied to everything from tying shoelaces to social skills and conversation.”

Living in Australia, they found no centers or schools offering ABA therapy and the resources that Jack needed. Wanting to expose Jack to ABA therapy in the hopes that it would help him, Ian and Nicole dedicated themselves to giving Jack the support he needed and turned their house into their own early intervention center. “You’d walk into the house and there’d be labels on things and a big whiteboard and words written on it…and computer screens,” Ian Rogerson explains. “We decided he needed roughly 25 hours a week in that first year of one-on-one therapy,” Nicole said.  

Ian and Jack were determined to mainstream school their son and were eventually able to place him in a public school in Sydney. Jack had an ABA trained helped with him at all times at first to help him adjust to certain routines and behaviors but by the end of his elentary years his ABA helped was only needed for a few hours a week.

Jack went on to the Special Education Inclusion Program where he learned academics as well as domestic life skills. Director of students, Adam Lewis, says, Jack’s help a leadership role this year as a house monitor…He speaks well and politely to the younger guys, he has very high standards himself in terms of how he presents and his own conduct.”

In 2003 Nicole Rogerson decided to team up with Elizabeth Watson to open and establish their own center that specialized in ABA therapy for children on the spectrum. Nicole says she was impressed with Jack’s progress after the therapy. And is now CEO if the non-profit Autism Awareness Australia. She says, “Intensive ABA programs are still the only thing that come out as showing any evidence whatsoever of efficacy, and they’re still not funding it. Unless the government makes a genuine investment in this area, so many children are not going to reach their best outcome and I think that’s a tragedy.”

Shema Kolainu is committed to providing resources for parents and families in all five boroughs and offers a variety of therapies. All of our programs are individualized and based on the science of Applied Behavioral Analysis. To read more about ABA therapy and all the therapies offered by Shema Kolainu, click HERE

HELP MORE CHILDREN RECEIVE ABA SERVICES, CLICK HERE  

To read the original story, click HERE



Tablets Help Autistic Kids Maximize Language Skills

A recent study published in the Journal of the American Academy of Child & Adolescent Psychiatry suggests that using tablets with speech generating applications in the context of blended, adaptive treatment can help minimally verbal children make significant and rapid gains in their language skills.

For the study, 61 minimally verbal children with autism aged 5to 8 years old participated in six months of therapy geared towards improving language skills, play skills, and social skills. Half of the children were given a tablet to use during the therapy sessions loaded with a speech-generating app programmed with pictures objects used during the therapy. These children were able to touch a picture of an object they were using in therapy and hear an audio file of the objects’ names.

The study found that the children with tablets were much more likely to begin using language on their own, especially when they used the tablets from the beginning of therapy. The children appeared to have retained their skills when followed up on three months later.

“It was remarkable how well the tablet worked in providing access to communication for these children,” said Connie Kasari of the University of California, Los Angeles. “Children who received the behavioral intervention along with the tablet to support their communication attempts made much faster progress in learning to communicate, and especially in using spoken language.”

Shema Kolainu Hear Our Voices School and Center for Children with Autism is launching it’s iPad program this year. We will be sure to keep you posted!



Can Babies Exhibit Symptoms of Autism?

Sally Rogers, professor of psychiatry and behavioral sciences at the University of California-Davis MIND Institute, conducted a study that looked at treating subtle but telling signs of autism in babies. The findings, recently published in the Journal of Autism and Developmental Disorders, gives further evidence to support the idea that early intervention can help your child be more successful as their brains are still so flexible as a baby. Though study was quite small, including only seven infants who exhibited potential symptoms of autism, the results were promising. It is difficult to find infants who are likely to have autism since it is usually diagnosed in the toddler years.

Dr. Rogers explains that babies who may be at risk of developing autism exhibited the following symptoms:

  • Spending too much time looking at an object. Typically developing babies do look at objects but eventually they’ll do something with it for example, banging it, showing it to someone else, etc.
  • Showing signs of repetitive behaviors. For example, one little boy kept dropping the lid in a certain way to try to get it to spin.
  • Don’t exhibit any sort of communication or connection to parent. For example, they rarely make eye contact, smile, or look at the parent even if the parent is doing something interesting
  • They’re not trying to use their vocal chords often as typically developing babies do. Laughing and making baby sounds is part of them learning and wanting to communicate with the people and things in their environment.
  • Babies exhibiting these symptoms consistently for over two weeks are a good indicator that you may consider getting your baby screened for ASD.

Dr. Rogers helped the parents take the lead in the treatment process by coaching them on the “Denver Model,” which is all about having the child enjoy the rewards of social interaction. For example one mom, while playing patty-cake with her baby’s feet started playing a little too roughly and her baby made a sound, signaling the mom to stop. While smiling is enough to establish a connection for typically developing babies, others respond to different cues. The aim of this model is to give parents and caregivers the tools and knowledge to help their baby if they see symptoms.

She states, “I am not trying to change the strengths that people with ASD bring to this world…My goal is for children and adults on with autism to be able to participate in everyday life and in all aspects of the community in which they want to participate.”

For more information, click HERE



The “Little Brain” & It’s Big Influence

(Applied to autism, cerebellar injury could hinder how other areas of the brain interpret external stimuli and organize internal processes. Based on a review of existing research, the researchers found that a cerebellar injury at birth can make a person 36 times more likely to score highly on autism screening tests, and is the largest uninherited risk. Credit: Samuel Wang)

As researchers dig into the root causes for autism, they are finding that our cerebellum or “little brain” may play a bigger role in shaping our cognitive and language abilities than previously thought, especially in the prenatal phase. The cerebellum actually only makes up a total of 10 percent of our brain’s mass, but is the home of 50 percent of it’s neurons. The cerebellum is usually associated with movement and coordination, so a doctor checking for damage in the cerebellum would conduct a number of tests that check balance and motion. However, a recent study published in the journal Neuron suggests that dysfunction in the cerebellum in crucial moments during development could be one of the leading contributors to autism spectrum disorders as well as other neurodevelopmental disorders.

Dr. Samuel Wang, associate professor of molecular biology and neuroscience at Princeton University, and his research team, put forward the theory that the cerebellum is not only responsible for movement but also for helping developing minds process more complex sensory information that also aids in establishing social bonds. He explains, “Some of the clinical and animal-research evidence for cerebellar involvement in autism has been known for years, but this evidence doesn’t fit into the textbook wisdom that the cerebellum controls sensory processing and movement. At some level, researchers have been trapped by whatever framework they learned in college or grad school.”

In their study, Dr. Wang found that for children who experience damage to their cerebellum at birth are at an increased risk for ASD that he shows is comparable to the risk of a smoker developing lung cancer. So how is the cerebellum connected to developing “higher functioning” social and language capabilities? The study explains that a baby seeing their parent smile will eventually connect that experience to certain rewards that come along with it, for example being fed, which would overtime lead to the child’s ability to understand these social cues—a connection that is facilitated by the cerebellum. These connections that will eventually help with social behavior are especially vulnerable in the prenatal environment.

In Dr Wang’s words, “because the risk factor from cerebellar injury is bigger than any other know environmental risk, we think this provides deep insight into the basic biology of how ASD brains go off track. Problems in cerebellar function aren’t the (only) cause of autism, but they are potentially a significant cause of autism.” 

Studies like this one are important in developing best practices for treatment and therapy for those on the spectrum. Another recent clinical study published in the American Academy of Pediatrics issued new guidelines for physicians in diagnosing specific intellectual and developmental disabilities. The report argues that it is important to know the root of the child’s disability whenever possible in order to find the most appropriate treatment plans. Moreover, a better diagnosis will help families manage expectations and advocate for their child in the best way possible.



Study Finds Inclusive Classrooms Boost Language Skills

Inclusive Classrooms Can Boost Language Up to 40%

A new study published in Psychologilcal Science finds that young children with Autistic Spectrum Disorders (ASD), particularly those with speech delays, improve their language development more rapidly in inclusive educational and social environments. The study found that preschoolers with disabilities who attended mainstream classes were using language on par with their highly skilled peers within just one school year. In contrast, ASD preschoolers who were surrounded solely by other children with a similar level of disability lagged far behind their typically-developing peers in the same time frame.

The study focused on 670 preschoolers in Ohio, of which slightly more than half had a language impairment, autism, or Down syndrome. Language skills of all the children were measured at the beginning and end of the school year via standardized testing.

The children with disabilities in inclusive classrooms outperformed those in exclusive classrooms for children with disabilities by 40 percent at the end of the year. Laura Justice, a professor of teaching and learning at Ohio State University and co-author of the study concludes that, “the typically-developing children act as experts who can help their classmates who have disabilities.”

It should be noted that while the children with disabilities were positively influenced by their highly-skilled peers, the children with the highest skill level were in no way negatively impacted by their exposure to their peers with disabilities.

The findings of this study certainly indicate that children can only benefit from an inclusive setting where they can learn from more advanced children and assist less advanced children. “We have to give serious thought to how we organize our classrooms to give students with disabilities the best chance to succeed,” Justice said.