Friday, February 26, 2010

Part three - Communication Build Up

Communication Build Up

The number one challenge with children with Autism is communication. Anxiety and Sensory issues are a huge component also, but communication still reigns as the number one problem, because without it, the other two are bigger problems because now the child on top of it all cannot express to you why they are behaving the way that they are.

Communication problems are in more than one area. There is the fact that many children are not verbal, where they have few or no words, or they have a very limited vocabulary. Only children with Aspergers have a large vocabulary, sometimes even greater than typical children. But the communication issue does not stop just at the lack of words. It also is the inability to read body language, facial expressions, and the concept of personal space, the little nuances we use to convey meaning, and the biggest one that the world exists beyond ourselves.

Verbal ability is the easier one to teach, because you can show pictures of objects and activities and drill these ideas and pictures into a child’s head. This is where ABA (Applied Behavior Analysis) succeeds; it has been proven to dramatically increase a child’s vocabulary. We used it for 2 years and it greatly increased Noah’s vocabulary of less than 20 words, to that of a typical 5 year-old ( when he was 6) He still struggles in this area, because the English language does not always make literal sense.

Excerpt from Little Squares with Colors: a Different way to look at Autism

I have explained what a figure of speech is, but it seems to go in one ear and out the other. So I find it amusing most of the time. When I get a song stuck in my head Noah wants to see it, and now he offers to help rinse it out. Now that he has more language he can expand this a bit. Saying that it’s a disc in my head and we need water.

I first notice the literal thinking, when I teach him to wash his own hair.

“Ok, now you have the shampoo on your head, so put your hands on your head”

Noah does this while standing in the shower.

“Okay, now move your arms back and forth.”

He drops his arms to his side and swings them back and forth. After this I am more careful when explaining things, than I already was. I am especially concerned with explaining what would happen if he got shampoo in his eyes. I think it’s best to leave the burning part out, because I have the image of him seeing flames shooting from his eyes. And if he thought that, he would never use shampoo again.

I still have to watch the figures of speech; I really am surprised how many there are: Daddy’s on a roll! I am so hungry I could eat a horse!

Sometimes it’s best to not say anything.

The literal thinking is a later obstacle, what comes first is teaching a child the words for the things in their environment, and teaching them about their emotions, which is a very difficult task.

A Picture is worth a thousand words

Pictures are your friend in autism if your child is visual, which a great many of them are. Take pictures of everything your child interacts with on a regular basis, including the people in your life. Pictures are used to teach what an apple is, and who Aunt Jenny is or Uncle Mark. Noah every day had to go through a pile of cards with everyone pictures on it to memorize their faces with their name. Either by stating the name of the person in the picture, or by being told a name and he would have to touch the corresponding photo. Pictures can also be sequenced to teach an activity such as how to wash your hands. We also used pictures to teach Noah how to get ready for bed. The pictures were taken of his bathroom, the bathtub, sink, toilet, pictures of him washing his hands, drying them, turning off the TV, reading a story, and being tucked in. He would remove each picture after we did the task and placed in a bin at the bottom of the board. Then I would replace them the next day, you can do this for just about everything. And you do it, until one day, your child starts to do the tasks by your verbal prompt as opposed to the picture. I remember when I finally could but bedtime, to bed, such a feeling of satisfaction. Of course getting him to STAY in bed was a whole other issue, and I will save that for a different entry.

Emotions were harder to teach, he memorized the words from looking at the same pictures of people smiling, or looking angry, even bored. We had pictures of him also looking angry, bored, tired, happy, sad, and he did memorize the words, but I couldn’t get him to get the emotions. Not until I videoed them, I learned he was able to absorb the emotions from TV from one day watching the movie Homeward Bound. Near the end of the film when the pets are reunited after being separated its very overwhelming with joy and tears, and Noah, the man of few words started to cry. But it gave me the idea to make videos of him for him to watch. So we made lots of videos of Noah, and he learned to connect the feeling the video gave him, with being there also.

Patience is a virtue, and good teachers are saints

Teaching communication to children on the spectrum though goes in tandem with understanding the other two factors, anxiety and sensory issues. This is why I wrote about them in this blog first, because you have to understand these issues will influence how successful any learning will be. The best success we have had was when we understood this fact, utilizing small sessions with in the session. Letting him work with drills for short periods, and when he seemed fidgety, restless, needing to stim or just getting very frustrated it was time for a sensory break. And after an hour or so of work, a period of quiet alone time for him, which gave time for myself and the therapist to go over what we just accomplished.

Unfortunately science and therapists have not yet come up with a proven strategy to teach “theory of mind” (the ability to know things happen outside of your mind) or all of the smaller subtitles that come with communications, those things we take for granted. When we are tired and maybe are not interested in doing something, or when we are excited and want someone to share in that joy, these types of subtitles just elude autistics, and behavior therapy can be used to help control the more extreme emotions of the child, and the frustrations. But so far, learning personal space and concepts like it are more trained into the child as opposed to where they come naturally. And because there are so many, and we are all different, it is a nearly impossible task to expect people on the spectrum to “get something” that does not come naturally to them. It is no different than expecting a diabetic to just make their own insulin. But for now, there are no injections that can be given to a person that lacks this communication skill. There are dietary interventions that do help with this area and I will be covering them in the near future.

All you can do is your best, be tolerant, patient, and do not take anything personally. We all can work on our communication skills, children without them teach us how important our job is to teach them, and also how to better communicate with others. They also teach others who do naturally have the ability to communicate how fortunate they are, and maybe that will help encourage more bravery in those that lack it.

C. Dagnelli Author of Little Squares with Colors: A Different way to look at Autism

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