Autism - A Practical Guide for Parents

by Alan Yau

The difficulties in each area of the triad of impairments may be expressed in different behaviors, e.g. the difficulty in social interaction may be expressed in terms of aloof behavior, where the child will have little to do with others, or as over-familiar behavior, such as touching strangers in the street.

children with autism don’t process social information automatically, they have to try and work it all out – all this conscious processing can be exhausting, and having to “do social” for too long can lead to problems.

Difficulties around social interaction include: not understanding the unwritten social rules, e.g. around friendship; appearing to be insensitive because they have not recognized how someone is feeling (or don’t understand how they should react); not understanding other people’s intentions; not being able to predict other people’s feelings and reactions; becoming aloof, distant, or uninterested in other people as a result; not seeking comfort from other people; behaving strangely or inappropriately – because of not understanding what is appropriate in different social situations.

Difficulties with social communication include: difficulties understanding language; difficulties producing speech; unusual patterns of speech; repeating words or phrases; referring to self by name; not understanding the point of communicating; not pointing out things of interest to others; not understanding tone of voice, facial expressions, body posture, gesture, body distance, and volume of speech; not being able to read the signs that tell you whether to continue talking or to stop; the tendency to take language literally, which makes it difficult to understand jokes, sarcasm and figures of speech.

It’s not so much that children with autism can’t imagine, it’s that their thinking tends to be more rigid, less flexible; and this rigidity in thinking has far reaching consequences.

Difficulties include: having narrow interests and obsessions; having to have things a certain way – e.g. all the doors need to be shut; having to do things a certain way; finding it hard to predict and anticipate; poor generalization of learning.

A child with autism may insist on creating order in the parts of the world that he can control, because he is mystified by much that is outside his control. Structure and routine can help to support a child with autism, as it provides a safe familiar framework for learning to occur within.

If your child is always on the move and likes to spin, it may be their vestibular system is hypo-sensitive – and they are seeking out those sensory inputs. Conversely, if your child dislikes having their feet off the ground and hates spinning and jumping, may be their vestibular system is hyper-sensitive. And if your child bumps or trips over people and things, or looks at their feet when walking downstairs perhaps their sense of body awareness is hypo-sensitive, whereas if they don’t like other people being too close they may be hyper-sensitive. Their behavior may be a way of getting their sensory needs met.

We are all better at some things than others, it’s a part of what makes us all individuals. However, people with autism often have a very uneven profile of skills, with a marked difference in their abilities in some areas compared to others; they often show strengths in those areas that are independent of social understanding, e.g. manipulating numbers or working with computers. The difficulty is that people often assume that a child who is academically capable, for example, should be equally capable in other areas. This is particularly a problem in school when more able children with autism get in trouble because they just don’t understand the subtle social rules, despite their relative intelligence.

A particular characteristic can be a strength or a difficulty depending on our perception and the situation.

Seeing things in terms of black or white, good or bad, right or wrong can be great in terms of achievement (having high standards, great attention to detail, etc.), but it can have a high price when things don’t go as your child expects.

It may be that there are sensory issues that prevent him from acting. He is using all his mental resources to cope with it, and has no spare capacity to do what you are asking. It may be that he simply doesn’t understand what you want him to do, or that he is anxious about doing it wrong. It may be that there is something that he HAS to do before he can do your thing, and you are preventing him from doing it.

Perhaps there’s a certain order that your child has to have things done in – and he may not have the understanding he needs to communicate that to you.

So you have a choice, do you make use of what already engages your child in your intervention program or do you ignore it and try and impose a program on them?

I’m talking about the kind of play where your focus is entirely on your child – giving them your full attention, despite all the other demands on your time. The kind of play where you lose yourself in the interaction, and you share precious moments together.

The thing is, if you are able to keep going with the Intensive Play despite the lack of the right input, you will find that your child is actually giving you lots of feedback – in their own unique way.

Sure you may have a whole ton of goals for your child, but while you are engaged in Intensive Play, those are side issues. The important thing is for your child to enjoy the experience of playing with you, and to build a relationship based on trust and mutual enjoyment.

Intensive Play creates that trust – I have worked with many children who would do little for anyone else, but who would nevertheless happily do what I asked. I put this down to trust and the fact that I joined the child in their world, rather than always trying to pull them into ours.

Using the schedule should be the safe, familiar routine – the flexibility is that the tasks in the schedule can and should change.

So often we let children do things the wrong way and then try to correct them. While this may be a good way for some children to learn, it probably isn’t the best way for a child with autism, especially for one who likes things to be the same each time. For some children with autism, the way something is done the first time is the right way and they can be very resistant to being corrected later.

It’s important to understand that these may be possible coping strategies. A sudden increase in certain repetitive behaviors, and resistance to interruption, is sometimes an indication of loss of well-being. If you sense that your child is not in a good state, it is really important that you help them get back to a better state before you start making lots of demands of them.

instead of giving your child a long time at a favorite activity, try shorter periods several times a day – this is easier if the activity has a natural ending. Try the same thing with favorite snacks.

Imagine you have a bottle of fizzy drink that you had accidentally shaken or dropped. Now imagine you are super thirsty and you really want to have a drink. Do you just take the lid off right away so you can have your drink? Or do you let it settle down first, gently loosening the lid to let the fizz escape slowly? Now imagine you’re with your child, and something has got them really fizzed up. And you’re in a hurry. Do you continue to rush them, or do you give them time to settle and for the fizz to escape?

You know your child, base your expectations on what you know, rather than what you wish.

So, put all your energies into making extreme whoops of delight when you are pleased with your child’s behavior, and make the minimum of fuss when they engage in behaviors that are unacceptable to you. Practice being boring when your child behaves in a way that is not appropriate.

Of course, you will want to reward your child for when they are behaving appropriately. Remember though that your child may not be as motivated by pleasing you as they are by getting access to a favorite toy.

To a child with autism, this may be extremely unhelpful, particularly if he or she has processing delays – they may still be trying to process what we originally told them when we suddenly assault them with yet more words to process. If that happens they may give up trying to process what you said originally to deal with this new message.

Keep your sentences at a level that your child can cope with, and be aware that at different times this level may well vary. For example, in more stressful situations your child may find it more difficult to cope with even fairly short sentences.

Reduce the social demands when teaching your child something. Is it really necessary for them to look at you when you are talking? Does that make the task easier or harder for your child? Are you expecting your child to share equipment, take turns, etc. as well as learn a new activity? Could your child learn the activity first before you expect them to incorporate these social aspects into it? Does it really help if you talk at the same time? Or is it just another bit of sensory information that your child has to process when they are trying hard to learn a new skill?

What need is being met by your child doing what they are doing? Can they get that another way? So when your child is behaving in a way that is unacceptable, ask yourself, what could my child do instead?

If your child could communicate to you exactly what they needed to behave well, they would probably already be doing so.

First of all, have a good think about whether the behavior really is a problem. Is there an actual cost to your child, or other people, associated with the behavior, or is it just something unusual that you’d rather they didn’t do? Perhaps the behavior just presses one of your buttons, and it’s not a problem for anyone else?

The longer a behavior is in place, the harder it is to change.

If your child always gets something he likes out of behaving the way he does, then he is likely to keep behaving the same way. Sometimes it’s more obvious, e.g. if we were to give a child some candy to calm them down. However, it may be that the thing your child “likes” is to get out of doing something he doesn’t like. Or it may be that the thing he “likes” is the way your face looks when you are cross and steam is coming out of your ears. Or it may be that people leave him alone when he behaves that way, or he gets taken somewhere quiet. I’m not saying that your child is aware of this consciously, although they might be. I’m just saying that the consequences, however unintended, may be something to look at as possible fuel for the behavior.

When your child is upset, their ability to process information is going to be further impaired. If you are giving directions, pare down what you say to the absolute minimum.

While one person waited with Tim, giving him positive directions when needed, a colleague went to fetch cookies and a drink. Tim’s violent behavior was communicating that he was hungry, so we wanted to attend to that, without rewarding the behavior by letting him into the dining-hall and thereby making it more likely that he would repeat the behavior in the future.

However, communication difficulties are at the core of autism, so don’t assume that just because a child can speak, they will be able to communicate their upset in a calm, measured way.

you want your child to know that if they can’t do something, help is available, it’s not the end of the world, and they have a way to ask. Once your child has a way of asking for help, give them lots of practice in different situations so that they learn to generalize the skill. Remember generalizing does not come naturally for many children with autism.

The third part of the triad is “rigidity of thought”. Children with autism have difficulties with understanding the world, and may engage in repetitive behaviors because they are predictable and comforting. For many children this is expressed in doing some activities over and over again, for others there may be a particular interest in certain things, for example train timetables.

For a comprehensive guide to sleep issues, I recommend “Sleep Better: A guide to improving sleep for children with special needs” by V Mark Durand (see resources page).