Principles of Reinforcement

Reinforcers – in a nutshell, are necessary and effective when used correctly.  A common misconception is that reinforcement is bribery.  This is only true if used incorrectly.

Reinforcement is defined as an event that follows a behavior, which increases that behavior.

We all respond to reinforcement, or the lack of it.  We go to work, because we get a paycheck.  We clean the house because we enjoy the results.  In the absence of reinforcement, the behaviors that have usually produced them decrease.  I love my job, but if I didn't get paid to do it, I'd do it less, and other behaviors that did produce reinforcement (pay) would increase.

But reinforcement for children in therapy situations does not have to look like a trainer holding a Scooby snack in front of a dog, saying, "sit" (translate that picture into a teacher and a child sitting perfectly at a table, with the teacher delivering an endless stream of instructions and m&ms).  There are many different ways to deliver reinforcement effectively, such as variation in frequency and type. 

Another big idea -- reinforcers don’t have to be treats.  Sometimes an exaggerated “woo hoo”, high five, tickle or hug is all it takes.  The most effective reinforcement system depends on each child’s abilities and interests.  You need to know what is most interesting and desirable for the child, and remember that this can change, sometimes quickly.

Why is Categorization Important?

I did the math.  I have 80% of my clients working on categorization at some level.  Why?

One of the ways people organize their world is through categorization. Typically, young children seem to absorb the concept of categorization effortlessly through play, talking with others and participating in everyday experiences. Children and youth with autism spectrum disorders (ASD) often have difficulty learning to use categorization strategies effectively and therefore may require systematic instruction to develop and use them effectively.

Effective categorization skills enable us to perform tasks efficiently. Daily life without categorization could lead to a situation such as the following. In order to make dinner, you need to get the meat from the freezer in the garage, a frying pan off the coffee table in the living room, potatoes from the bottom dresser drawer in the bedroom, forks from the box on the top shelf in the bathroom, knives from the TV cabinet, and then you need to cook the food on the stove in the basement before bringing it up to serve it on the table in the dining room. This sounds absurd but this situation could occur if categorization were not used to organize things according to how they are used.

Beyond using categories, we must use the correct categories. Imagine going to the dining room section of a furniture store to buy milk, or going to buy a bike or a horse at the car dealership. After all, they are both things to ride on. 

Why Is Categorization So Important?

The ability to group things according to a common characteristic and then name that characteristic is a basic concept that helps children form a basis for structuring and organizing their world. When you systematically teach categorization skills, you are not just teaching a single skill but a system for learning, problem solving and organizing.  You are also teaching the foundation for processing, remembering and integrating new information. Many of us marvel at and even envy people who are always able to put their finger on an object or piece of information when needed because they know where to find it. This would not be possible without having developed complex organization strategies that include categorization.  I like to explain it as a filing system.  As a child learns new words, he needs a place to put them, knowing how they relate to other words.  Think of how you retrieve a word that is eluding you momentarily -- "It's like ___", "It's a (category)", "Not a __, but ___".  You might even recall connecting details such as where you saw this thing, who you were with, etc.

How Do Children Learn to Categorize?

Matt is going for a walk in the neighborhood with his dad. He points to a cocker spaniel running after a frisbee and says, "Kitty." His dad corrects him saying, "No, that’s a dog." Matt says, "Dog." Further along on the walk Matt sees an Irish Setter. He immediately points to it and says, "Dog." His dad responds, "Yes. That’s a big red dog." Matt is beginning to learn the category of "dogs."

Through a variety of experiences that include seeing and hearing others talk about dogs of different breeds, as well as being corrected when he uses a different word for a dog, Matt is learning what does and does not fit under the category of "dog." Although this seems very simple, consider all the skills Matt needs to have in order to reach this understanding.  Matt needs to learn the common features of dogs, such as: fur, four legs, two ears, tail, two eyes, long nose, teeth, and tongue. But that is not enough, as obviously many other animals have those same features (cats, cow, horses, raccoons, etc.). Therefore, Matt must also learn what a dog is not. And then he must learn that there are many variations (color, size, shape, length of fur, size and shape of ears, differences in the sounds they make). Eventually, he will also learn there may be exceptions to the rules (no tail, pug nose).

Simultaneously, Matt will learn about many other categories of familiar things around him. He will learn that dogs, birds and fish all belong to a category called animals. He will learn that foods are something to eat, while cars, busses and bicycles are things people ride. Flowers, trees and grass are called plants, and plants and animals are living things. Rocks, water and rugs, on the other hand, are not living things.  Matt will learn that things can be grouped or categorized in many different ways. For instance, items can be grouped by what they look like, what they are made of or how they are used. For Matt, the ability to grasp the concepts involved in understanding increasingly complex categorization skills develops so easily and naturally that his parents and others around him are unaware that they are teaching him an essential skill for organizing his world. 

Why Is Categorization So Difficult for Children and Youth with ASD?

Categorization can be very confusing to people with ASD. To many, it can be a totally foreign, perplexing concept. Why is that?

Different Ways of Thinking

As a woman with very high-functioning autism, Temple Grandin says that she thinks "in pictures" whereas most typical people think in words. Words help people categorize. In Thinking in Pictures and Other Reports from my Life with Autism, Temple Grandin describes the way she thinks of dogs.

... my concept of dogs is ... linked to every dog I’ve ever known. It’s as if I have a card catalog of dogs I have seen, complete with pictures, which continually grows as I add more examples to my video library. If I think about Great Danes, the first memory that pops into my head is Dansk, the Great Dane owned by the headmaster at my high school. The next Great Dane I visualize is Helga, who was Dansk’s replacement. The next is my aunt’s dog in Arizona, and my final image comes from an advertisement for Fitwell seat covers that featured that kind of dog. My memories usually appear in my imagination in strict chronological order, and the images I visualize are always specific. There is no generic, generalized Great Dane. (Grandin, 1995)

Could you imagine how challenging it would be for most of us to have to go through a visual list in your mind when someone simply mentions the word "dog?"

Teaching Categorizations skills

General hierarchy:

• Match identical objects and pictures
• Sort a group of objects or pictures into two identical sets 
• Sort a group of objects by one feature
• Choose an item to match a given category description or name
• Sort into 2 and 3 categories
• Name categories
• What doesn't belong and why
• What goes together and why
• Name multiple items of a given category
• Express similarities and differences

Need some ideas, feel free to comment or contact me :)

Dawn 

 some information adapted from Academic Interventions

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Are you tired?

Sleep disruption in children with ASD

Sleep disorders may be more common in children with autism. Researchers estimate that between 40% and 80% of children with autism have difficulty sleeping. The biggest sleep problems among these children include:

•                Difficulty falling asleep

•                Inconsistent sleep routines

•                Restlessness or poor sleep quality

•                Waking early and waking frequently

A lack of a good night's sleep can affect not only the child, but everyone in his or her family. If you're bleary-eyed from night after night of waking up with your child, there are a number of lifestyle interventions and sleep aids that can help.

What causes sleep disorders in children with autism?

Researchers don't know for sure why autistic children have problems with sleep, but they have several theories. The first has to do with social cues. People know when it's time to go to sleep at night, thanks to the normal cycles of light and dark and the body's circadian rhythms. But they also use social cues. For example, children may see their siblings getting ready for bed. Children with autism, who often have difficulty communicating, may misinterpret or fail to understand these cues.

Another theory has to do with the hormone melatonin, which normally helps regulate sleep-wake cycles. To make melatonin, the body needs an amino acid called tryptophan, which research has found to be either higher or lower than normal in children with autism. Typically, melatonin levels rise in response to darkness (at night) and dip during the daylight hours. Studies have shown that some children with autism don't release melatonin at the correct times of day. Instead, they have high levels of melatonin during the daytime and lower levels at night.

Another reason children with autism may have trouble falling asleep or awaken in the middle of the night could be an increased sensitivity to outside stimuli, such as touch or sound. While most kids continue to sleep soundly while their mother opens the bedroom door or tucks in the covers, a child with autism might wake up abruptly.

Anxiety is another possible condition that could adversely affect sleep. Children with autism tend to test higher than other children for anxiety.

What kind of effects do sleep problems have?                                                                       

Not getting a good night's sleep can have a serious impact on a child's life and overall health. Research has shown that, in children with autism, there is a connection between lack of sleep and the following characteristics:

•                Aggression

•                Depression

•                Hyperactivity

•                Increased behavioral problems

•                Irritability

•                Poor learning and cognitive performance

If your child isn't sleeping, there's a good chance you aren't, either. One study showed that the parents of autistic children sleep less, have poorer sleep quality, and wake up earlier than parents of non-autistic children.

How do I know whether my child has a sleep disorder?

Every child needs a slightly different amount of sleep. In general, these are the amounts of sleep children require, by age:

•                Ages 1-3: 12-14 hours of sleep per day

•                Ages 3-6: 10-12 hours of sleep per day

•                Ages 7-12: 10-11 hours of sleep per day

•                 

If your child regularly has difficulty falling asleep or wakes up repeatedly throughout the night, it might be a sign of a sleep problem. To know for sure, make an appointment with your child's pediatrician. The doctor may refer you to a sleep specialist or an ear, nose and throat doctor.

It can help to keep a sleep diary for a week to track how much and when your child is sleeping. You may include any snoring, changes in breathing patterns or difficulty breathing. You can share this diary with your child's doctor and any specialist involved in treatment.

How can I help my child sleep better?

Sleep medications are generally used as a last resort with children. There are a number of lifestyle changes and natural sleep aids that can improve sleep time and quality in kids with autism:

•                Avoid giving your child stimulants such as caffeine and sugar before bed.

•                Establish a nighttime routine: give your child a bath, read a story, and put him or her to bed at the same time every night.

•                Help your child relax before bed by reading a book, giving a gentle back massage, or turning on soft music. 

•                Shut down television, video games, and other stimulating activities at least an hour before bedtime.

•                To prevent sensory distractions during the night, put heavy curtains on your child's windows to block out the light, install thick carpeting, and make sure the door doesn't creak.

•                Ask your pediatrician about giving your child melatonin just before bedtime. This dietary supplement is often used as a sleep aid to help people get over jet lag. It may help normalize sleep-wake cycles in autistic children who have sleeping issues, and research done so far finds that it's safe and effective.

Adapted from WebMD

Stop Trying to Get your Child to Talk

What?!  Speech therapist is saying to stop trying to get your child to talk?  Well, yeah, but here's what I mean.

For some kids, repeatedly asking him/her (just gonna use "him" from here on) to say words for you doesn't really help him learn language.  It can have the opposite effect because it takes the joy out of communication and triggers the "stubborn" in some kids.  The desire to communicate comes from having something to say and knowing someone will listen.  So, instead of making your child repeat words after you, let him lead the communication and then follow that lead.  If you need to remind yourself to take the pressure off, a good rule of thumb is "Don't say say."  Plus, some kids, especially those with ASD, may echo the behavior (adding "say" before they talk), or may learn to rely on the prompt instead of learning to communicate independently.

For example, prompting your child to say "hi" or "bye" to visitors. (Can you hear yourself doing it?  "Say hi, say hi to grandma, Johnny say hi, say hi.."  Don't worry, we have all been there!)

Instead:

• get down on the child's level, 
• try to secure attention and eye contact, 
• be very excited and expressive in your facial gestures 
• and simply say "Hi!" 
• Then WAIT expectantly (count slowly to 3 to yourself if you need to - sometimes kids need time to process).

Will your child respond immediately?  Maybe, maybe not, maybe over time... but I prefer this more natural way of teaching language and have seen it work.

Dawn Gummersall, M.S., CCC-SLP

some info adapted from It Takes Two to Talk, by Jan Pepper and Elaine Weitzman  -- a great resource for anyone looking for ideas on developing early language

Conversational Therapy

So, I’m sitting on the couch in the home of one of my clients – a beautiful 4-year-old girl, whom I adore.  I have lugged in my huge bag of stuff – activities I have planned to target the language skills we are building.  But, as this is just after Christmas, as well as a vacation for her, she is full of things to tell me.  This is such a joy to me.  I’ve known this little girl since she was barely verbal and on this day, I can barely get a word in edgewise.  So, in addition to just enjoying her enthusiasm, I am reminded to “kick in” my therapist side and make the most of this in supporting and furthering her conversational skills. 

Following are some of the ideas I used with her and some others for beginning conversational partners. 

But, first:  by “beginning conversational partners”, I am referring to children who are just expanding their skills in this interactive way, but not yet proficient in maintaining or adequately holding up their end of the conversational thread. 

Basically, a beginning conversational partner:

·       Has some advanced language abilities (e.g., combines 3 or more words together, can answer and ask simple wh questions)

·       Has social awareness of others

·       Is able to reflect on situations and consider different perspectives

·       Is able to inhibit behaviors based on social and moral rules

And next:  conversation as defined as a two-way communication in which each person takes a turn at the right time, sending messages back and forth. 

Formally, the Rules of Conversation are:

·      Pay attention to the person you’re interacting with

·      Start conversations

·      Respond when others start conversations

·      Take a turn at the right time

·      Give the other person a chance to take a turn

·      Continue taking turns, staying on topic

·      Consider the other person’s words, body language and point of view

·      Clarify or “say it another way” when your listener doesn’t understand

·      Ask the other person for clarification when needed

·      Change the topic when suitable

·      End the conversation appropriately

There are a lot of rules and even adults have trouble following them all.  Just imagine how difficult it is for your child to learn them!  S/He is going to need your guidance and support to learn how to have conversations that are rewarding for both of you. 

So, then: the ideas.

1.  Decrease questions, increase comments.  This allows your child opportunity to develop his/her own thoughts further.

Many parents find themselves asking their children question after question in an effort to get a response.  If you find yourself asking your child many questions, you’re not alone.  It’s a natural reaction when your child has communication difficulties.  But too many questions may turn your child off conversations.  So, to limit the number of questions you ask your child, turn some of your questions into comments or statements.

Instead of a question                          -----             Try a comment

“What’s that?  Is that a bird?”            ------               “Hello, bird!”

“That’s a big truck, isn’t it?”              -----               “Big truck.”

“Do you like that juice?”                        -----              “Mmmm! I like this juice.”

Balance your questions with comments.  Here’s a general guideline:  For every question you ask your child, try to make at least 2 comments.

Questions can be conversation stoppers when there are too many, or when you ask questions that your child doesn’t have time to answer, that test your child’s knowledge, are too hard for your child to answer, don’t have anything to do with what your child is interested in, or answer themselves.

(okay now that I harped on reducing questions…)

2.  Question for clarification.  Help your child recognize missing listener information.  This doesn’t, however, always need to be phrased as a question.  For example, my client was telling me about sledding in the snow and about “the blue”.  So I tried, “the blue …?”.  This would be an example of a least intrusive prompt, but in this case I didn’t get clarification.  So I went on to asking, “Was it a blue sled?”  Reply, “no, it was a tube! A blue tube and …”, the conversation continued. 

3.  Redirect for topic maintenance.  Again, as an example with my girl, our conversation continued, but then took a turn into telling about a recently seen movie.  I acknowledged the information (“oh, you are telling me about …”), but then I redirected (“but we were talking about …, tell me more about …”).

4.  Add your own information on the topic.  Allow your child the opportunity to respond to your perspective.  If your child is talking about sledding, add comments such as “I liked when _____!”, or “It’s cold when the snow gets on my face.”  Then allow time for your child to reflect and try to act on your ideas.  Don’t be discouraged however if s/he doesn’t right away, but instead goes on talking about his/her own experience.  This is a more difficult task to take on, but will come with time.

Feel free to comment or send further questions!

Happy New Year and fun conversations,

Dawn

Toys!!

Engaging children with ASD in play can be challenging. We want toys that stimulate and assist in development, but play also needs to reflect enjoyment for the child, and provide an outlet for stress relief and coping.  Here are some things to consider:

Special Interests

When choosing toys, think about what the child likes. Many kids with ASD have a deep interest in a special subject. Does the child you are shopping for have an interest in a particular subject? If so, look at gifts in these areas. If the child is interested in dinosaurs, cars, or planes, then look at toys or books related to this area. The only risk here is that s/he can rely too much on a single interest and not be challenged to try and engage in other areas where interest lacks.  At the same time, don't overdo the functional play.  There are times during which it is fine to let your child simply enjoy a line of toys that is pure fun. Balance is important. 

Developmental Ability

Consider developmental ability rather than age. Some children may be in grade school, yet their developmental age may be closer to preschool.  Good toys for children with autism who interact very little with other people are cause-and-effect toys. These toys teach that actions can cause something in the environment to change and can provide simple positive interactions between the child and others.  A child who is beginning to notice peers might be ready for simple turn-taking games.

Look for Toys that Stimulate the Senses

Is the child visually oriented? If so, think about interesting visual toys or items such as disco lamps, sand panels, light twirlers or fountains. Does s/he seek to touch lots of things? If so, think about toys that are tactile. Good tactile sensory toys for children with autism must be durable and interesting to touch. Some popular sensory toys include those with vibration, tangle or fidget toys, and toys with interesting textures (e.g., books with cloth, foil, yarn, etc. attached to them, or toys with bumps, fur, raised elements, ridges, etc).

Toys that Help Social Interaction and Language Development

Teaching all children cooperation through toys is an important rite of growing up. For children with ASD, socially interactive toys are even more important for helping them to develop coping mechanisms when interacting with the wider world. Board games are excellent for this, especially when the whole family pitches in to play together. Focus especially on the issue of taking turns and not getting uptight about losing. All children need to learn these skills but the frustration element can be very intense for children on the spectrum.

Toys that Develop Motor Skills

It's really no different from what all children need but you might have to face tactile defensiveness, inability to balance, fears, etc.  Many children have difficulty with fine motor skills. These are skills that require them to use their fingers and hands (like holding a pencil). Simple fine motor toys that are fun can also help children on the autism spectrum develop this essential skill.

Select quality over quantity. Too many toys can feel overwhelming and crowding. It is better to choose one good quality toy over many cheaper toys that will create great clutter. If you hit the right choice, that one toy will provide many hours of enjoyment.

Search online. There are numerous stores catering to toys for children with special needs, offering advice, good ideas, and unique products.

Information adapted from

www.nationalautismresources.com

www.autismspeaks.org

Gesture as Communication

Do you remember when your child said his/her first word?  Or, are you still waiting to hear it?  It is a moment every parent looks forward to -- the chance to communicate with your child.  But look closely, there are so many more ways that your baby can communicate with you.

 (side note: by "baby", I mean children of any age! - mine will forever be my babies no matter how old they are!)

So today, consider the gestures your child uses to communicate with you. Yes, gestures are an important part of communication, at all ages.

Gestures are actions produced with intent to communicate.  Gestures are expressed using fingers, hands, and arms, but can also include facial features. Early examples include open-handed reaching, reaching up to indicate want to be held, pushing objects away in protest, and arm flailing. The importance of gestural communication is often underestimated. 

Children learn gesture through observational and imitative learning.  There is an important social interaction component to this imitative learning that is required. Communication must be developed from social interaction.  In other words, digital entertainment or TV will not develop communication that can be interpreted and used in natural contexts. Many children with autism spectrum disorders will use scripts derived from TV programs, movies, commercials, etc.   While this is a form of language learning, it is not initially functional for 2-way communication.

Developmental Examples of Gestural Communication

• protest by body signal (e.g., back arching), or push away objects
• request by pointing, reaching, or making physical contact with an adult
• request action by reaching to be picked up, or performing an action to indicate want for something to reoccur
• seek attention by banging objects together, use body movements, or taking an adult's hand
• demonstrate anticipation of social games (e.g., peek-a-boo, song/finger plays)
• use of representational gestures such as waving goodbye and imitating clapping
• demonstrate shared attention by showing and giving objects

• request by looking at the object, then the adult, and then the object
• request actions by giving an object to an adult for help
• demonstrate the functions of objects such as brushing hair with a brush, putting on a hat, or stirring with a spoon
• point to objects or events for shared attention

• protest by shaking head for “no"
• request by reaching while opening and closing hands to obtain an object
• point to get someone to do something (e.g. open a door, carry to another room)
• take the hand of an adult and guide a hand or body to do something (e.g. take adult hand and put it on stomach to get tickled).
• demonstrate actions such as smacking lips to indicate wanting something to eat
• share attention by pointing to objects upon request (e.g. “show me the ball” or “Where’s the doggie?”)
• request information by pointing at pictures or objects with the expectation that an adult will name it

• seek attention through “showing off” (e.g. sticking out tongue, making funny faces, making sounds to get a laugh, and performing fingerplays such as patty cake)
• use representational gestures such as shrugging shoulders or putting hands up to indicate “all done” or “where did it go?”  
• blow kisses, signal “shhh” with fingers to lips, nod with a “yes,” pretend to sleep, and use conventional gestures of excitement (e.g. high five).
• share attention by clarifying verbal messages with gesture (e.g. point to an object he/she has attempted to verbally label)

Watch for the ways your child is communicating with you via gestures, or start to encourage gestures as an "in road" to further development of social communicative interactions.

As always, feel free to contact us at Autism Journeys with any questions or concerns!

Dawn

Pairing: Your best relationship with a child

I've been thinking a lot lately about a concept called "pairing".  This is the process of "pairing" yourself with reinforcement so that a child or learner regards you as a positive experience in his or her life.  Before placing instructional demands on a learner, a trusting and rewarding relationship must be established.  Best results can only be achieved when a child enjoys spending time with you!

Ways to do this:

--- Start with FUN!  Find what is reinforcing to the child and supply it!, with no expectations.  Best of all is to find what is fun (or funny) to the child in play -- tickle, chase, fall over (yes, sometimes you being the clown is hilarious and endearing!!)  Is there a favorite song or comforting tune the child prefers?  Maybe it's a tangible item- if the child loves goldfish crackers, be the one who has them, if the child is fascinated by spinning objects, have the best ones!  Be the bearer of all good things!

--- Be in control of the reinforcing item or activity, so that the child has to go through you to get it.  (Examples, you have access to desired treats and entertainment, toys are out of reach, you play the most fun games like tickle, airplane, or I gotcha)

--- Do not supply or offer reinforcement if the child is engaged in any problem behavior (you don't want to reinforce the wrong behavior).


How do you know if you are "paired" with a child/learner?  Simply put --

    Does the child approach you or avoid you?

Hopefully, he or she runs to you with excitement!  But if not (and it can take time), keep working on being a positive, fun, rewarding addition to the child's life.

Dawn Gummersall
Speech/Language Pathologist

Building Communication Around Routines

The WHY of Communication 


There are a number of reasons why a child might use communication. Two very important and also very different reasons are:

to regulate others and get needs met

to share attention and experiences with others

For children with autism, while both of these communication functions may be difficult to learn, the second one is the most difficult. Our goals for communication training for children with autism include helping them increase both the regulatory function of communication and also increase their motivation and understanding of using communication in more purely social ways. We hope to help them realize that they can share experiences with others, that it is fun to do so, and that communication is a part of this sharing of experiences.

Why Use Routines? 


Routines are of high interest to children with autism. Learning and using routines are learning strengths. They like the predictability of routines and, left to their own devices, often establish their own rigid routines and become very upset if they are disrupted. By establishing a positive routine, and then disrupting it, we create an incentive for the child to communicate in order to re-establish the familiar routine.

Joint Activity Routines 


A joint activity routine is a powerful teaching tool for children with communication disorders. This term describes a routine in which the child and the adult engage in a meaningful activity together and communicative behaviors are taught within the routine of the activity. 

Key elements of Joint Activity Routines

·      They occur in a meaningful and functional context (such as a play routine, a bathing routine, etc.)

·      They use the child's interests and strengths.

·      They are social (involve 2 people) at the child's level of understanding (ranging from parallel, to cooperative, to turn-taking, to interactive)

The adult role is to:

set up the environment and introduce the activity

add visual supports to the routine (such as pictures, objects, print words)

repeat and establish the routine, and then

wait -- and cue the child with the visual supports as needed to continue the routine

Adapted from:  Susan Boswell, 
Division TEACCH, www.teacch.com

Another resource puts it like this: “Choose a routine that’s easy to repeat and that your child enjoys.  It could be a people game, a song, a rhyme, or a routine you’ve created.  Once your child is familiar with the routine, you can use it to SPARK an interaction.

SPARK

·      --Start the same way each time

·     ------- Plan your child’s turn.

·     -------------- Adjust the routine so your child can take his turn.

·   -----------------------   Repeat the same actions, sounds and words each time.

·     ------------------------------- Keep the end the same."

from:  It Takes Two to Talk, Jan Pepper and Elaine Weitzman