Helping Parents of Children with Autism | Tips for Counselors with Dr. Dawn Elise Snipes

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs. Register@allceus.com Counselortoolbox you I'd like to welcome everybody to today's presentation on helping parents of children with autism. And we're really going to be talking about what the person with autism needs as well as their caregivers. And I use the term children, but we know that some people with autism who are further along on the spectrum may not live independently, so they may have caregivers for the lion's share of their life. So I don't want you to think this is just for young children. This really applies to all people with autism and their family. We're going to move from a deficit space to a differences based approach to interaction. We really want to see people as with autism as neuroatypical. We want to describe the unique interpersonal needs of people with autism spectrum disorders, identify characteristics necessary to form secure attachments, and list at least five practices that caregivers and teachers can use to improve the connection with children on the autism spectrum. Now my little soapbox here. Before we get started, I am going to try very hard because I feel very strongly about calling people who have autism people, people with autism or people with autism spectrum disorders, not an autistic person putting the person before the diagnosis. That is not necessarily how much of the research is written, but I do think it's important to recognize that these are people and they are differently abled. Think about the time that you were overstimulated. For me I went to LaGuardia one time and it was like around Christmas time and it was easy insane. And I don't like being around large crowds to begin with. But LaGuardia was oh my gosh, crazy, crazy busy. People were bumping into each other and nobody was happy. I was completely overstimulated. It was very anxiety provoking for me and I am neurotypical. You know, I don't get overstimulated by lights or sounds or noises as easily as someone who is neuroatypical may for other people. You may think about your wedding, getting ready for your wedding and you know that day that you were trying to get your dress on and your bridesmaids were messing with your hair or your groomsmen or whatever was happening. There are times when you can be overstimulated or you were overly exposed to high levels of sensory input such as a concert, really loud noise. It can be overwhelming. Somebody's cologne on the bus or on the subway. My kids went to a daycare for a while. It was called O2B Kids. It was a great daycare. Lots of toys, great, exciting, stimulating environment. But it was overstimulating for anyone who was anywhere on the spectrum. The walls were all like neon yellows and purples and pinks, and it was wonderful for children who wanted that excitement. But for children who got overstimulated easily, you know, that was a little bit too much. And I don't think my son is, you know, anywhere on the spectrum. He may. When he was younger, because of his prematurity, he did have some. Some deficits, but that was overstimulating for him a lot of the times. And he had to have a place where he could go where when he was overstimulated. Now he was like 2 at the time. But it's important to recognize and encourage the person with autism to recognize what their triggers are for being overstimulated. Also, think about another time you had something wrong but couldn't seem to explain it. When I have something go wrong with the computer, and thankfully my husband is my chief technical officer, so he's used to it. But I will say it's not working or it's broken, and he's like, you need to give me more than that. And I've learned over the years to take screenshots and everything. Or when you go to the mechanic and you tell the mechanic that the car's making this intermittent squeaky sound. I hate the intermittent sounds because they never show up when you're at the. At the mechanic and you couldn't really explain it. Or you woke up one morning and you were just feeling completely overwhelmed. You woke up in a panic attack but didn't know why, and you couldn't explain it. You were just like, I feel awful today, and I don't know why. These are very common issues for people who are on the spectrum. They can get overstimulated very easily or understimulated. High levels of sensory input can be traumatic for them, especially somewhere like LaGuardia or a football game or something. You can feel. Feel unsafe in these sorts of situations. So the person with autism may feel unsafe, and that's one of the first aspects that contributes to traumatic injury. We do want to recognize that people with autism may have some symptoms or may develop ptsd. Not saying that they all will, but we don't want to discount the adverse childhood experiences that are unique to a person who is on the. Who has autism. Autism Spectrum issues. What was your mood like when you were overstimulated or had something wrong but couldn't explain it? You were probably frustrated. You were like, would you just please listen, please understand or please make it stop. Well, think about a person with autism. You know, that's kind of what they are trying to communicate, but they may be so overwhelmed and so dysregulated at that point that they can't. How was your concentration and what were your thoughts? Probably not good. Probably get me the hell out of here because I can't take it or I can't possibly focus on what's going on. And those are things we want to take into consideration. We also want to recognize that unfortunately there is a high correlation. There's not causation and it's definitely not one to one. I think it was about 40%, but I can't remember right now. There's a high correlation of ADHD symptoms in people with autism. So you take someone who is on the spectrum somewhere and put ADHD on top of that so they're having more difficulty with concentration and sitting still and filtering out stimuli. It can get just oppressively overwhelming. Remember that secure attachment helps people feel safe and loved. And we're going to talk about the acronym CRAVES throughout this presentation. And it stands for consistency, responsiveness, attention, validation, empathy and solutions. And these are the principles that caregivers and people who work with people with autism need to try to remember to help them establish that attachment. Remember that your primary attachment, your primary care caregiver, is not your only attachment relationship. As we get older, we develop adult attachments. Maybe not everything like we had with that one person in childhood. We may have somebody who's a good listener and somebody who can help us out, but we have multiple secure adult attachment relationships that are important for us to feel calm and safe and connected and accepted and all those things that attachment helps us do. So craves consistency in routines and expectations. This is super important for someone who is on the spectrum because routine, knowing what to expect is really important. They often. And I will preface the rest of this presentation by saying when you've met a person with autism, you've met a person with autism. No two people with autism are exactly alike. So you can't take anything textbook and apply it and expect it to work 100% of the time. Consistency in routines and expectations is usually something that is really important, helping people know what to expect. So there's not ambiguity, because ambiguity causes anxiety. Anxiety causes dysregulation, which can lead to Behavioral issues. We want to show responsiveness. We want to mirror and soothe behaviors. And this is true in all children, not just people who are on the spectrum. We want to mirror what they're feeling. If they're feeling distressed, you know, we can mirror similar distress. And you know, when my kids feel distressed, I feel distressed. I mean it's that authentic sharing there. So it's not hard to come up with when they are angry about something. You know, I can mirror to a certain extent their anger. I can say I can see how frustrated you are about what's going on, you know, and using those words and maybe using those non verbals to mirror how they're feeling and then also showing them how to calm down. I see how frustrated you are. Now let's both take a belly breath and exhale and let's do that two more times. You know, I obviously that's more appropriate with younger children, but this is what we're doing. We're mirroring how they're feeling and we're showing them instead of telling them, we're showing them how to self soothe. This is how I do it. Let's do it together. It's important for caregivers, and this includes teachers, school counselors, yada yada, to know the child's distress triggers and cues. There could be a variety of different things and that's one of the things that makes each person with autism even more unique as the things that stress them out may be very different. For some people it's high pitched noises. For some people it's not enough sensory stimulation. For other people it's, you know, flickering lights. We need to know what the child's cues are and the only place that comes from is, is meticulous note taking and attention by the parent. And that is exhausting for the parent. Don't get me wrong, that takes a lot of time. But most of those cues are not going to change a lot into adulthood. They may learn to deal with a lot of them better, but some of the cues are still going to be there. For example, if they're hypersensitive to smell when they're two, they're probably still going to be hypersensitive to smell. When they're 32, they may have learned ways to deal with it so it doesn't trigger the dysregulation to the same extent, but those cues are still going to be there. Keeping a list or a log of those cues and triggers and the vulnerabilities if Johnny doesn't get a good night's sleep, then he seems to be more dysregulated when exposed to his cues. For example, we want to provide early intervention that goes with responsiveness for caregivers. We want to prevent and mitigate any of these triggers possible, you know, if we know that Johnny is sensitive to really bright lights and that tends to cause him stress. We want to make sure that we have sunglasses in our backpack. If noises and sounds are triggering to Johnny, we want to make sure that we have noise canceling headphones and they have the big old headphones. For many children they have in ear earplugs that work enough that they don't have to wear around the big headphones and they feel less self conscious when they get when they're older. But helping them figure out how to mitigate things. If you've got to go to the airport, you've got to fly somewhere and you know that the sound and the hustle and bustle is going to be overwhelming. Packing what I call an emergency kit is going to be really important. And that may include headphones for noise canceling or sunglasses for helping the person block out changes in light. You know, how you fly up through the clouds and the light flickers. Whatever it is for the person, you want to provide early intervention whenever possible. Don't wait till the person is dysregulated. When you get to a place, let them know what's going to happen, prepare, plan, and then when you get to the airport, for example, give them the headphones so they can put them on so they don't even start to get dysregulated and accommodate the child's learning style and environmental preferences. Or when possible, we're going to talk more about learning style in a little while. But not all children want to be in a light colored room. Some children may choose a color. They want to be in a blue room. Okay, you know, whatever that is that works for them and helping them have safe spaces wherever they go that they can feel calm and comforted. Going to be really important and figuring out what that means for that child is going to be important. And that can be anything from weighted vests to sunglasses or whatever you want to call them that have colored lenses if they want to see things that are blue or working with the child give attention. And this is really important to praise the positive. You want to give unconditional positive regard, reminding the child or or the person regularly how much they're loved but also remembering to praise the positive how well they did when you went out to dinner or when you went out to lunch or how well they did. Being patient while they were standing, while you were standing in line at the grocery store is going to be really important. We want to validate their feelings, thoughts, and needs. They are theirs, just like your feelings, thoughts, and needs are okay. Radical acceptance. We talked about that a lot yesterday. We want to help validate the person who has autism and help them learn that their feelings, thoughts, and needs are okay. We want to provide empathy and try to get into their headspace a little bit, try to understand what's going on, knowing what triggers them. And if they're smaller, you know, if they're younger, getting down to their level and like on your knees and looking around and seeing what it looks like, laguardia from your knees is really overwhelming because there's lots of stuff going on above you and you can feel, you know, very small and very unsafe. Empathize with them and work with them to identify solutions. People with autism are. Are people, and they happen to be neurodevelopmentally different, but they are not broken. They are different. So identify ways to prevent and mitigate distress that are meaningful to the person. And when they're two, it might be harder to figure that out, but as they get older, giving them agency is going to be really important, and we're going to talk about that multiple times today. With children with autism, they may have slow speech development or not talking at all. This can be very difficult for parents because it's hard to connect and engage with a child who is nonverbal, who is mute, even, you know, especially if they won't even sign or cannot even sign. And not all children with autism are going to develop those verbal skills or non. Those communication skills at an early age, which can delay connection. And it can make it harder for a caregiver to be responsive to needs. If the child can't tell you what's wrong, then it's hard to be responsive. It's hard to know, oh, your ear hurts. I remember one time my son was like 18 months old, and he was irritable and fussy and ended up taking him to the doctor because he spiked a fever and. And turns out he had a double ear infection and one of his eardrums had burst and, you know, he hadn't had a fever for more than, like, six hours. And I felt horrible, you know, because he was still playing and he was being a little more irritable, but he was still playing with his toys and eating and not vomiting or anything. And I felt horrible because I didn't respond to those needs earlier, before the ear infection got bad. And y' all know I'm a big old baby when it comes to ear infections. But think about how that goes on continuously for someone who is on the spectrum. Even as they get older. If they are not able to communicate their needs, they may have trouble or inability to start a conversation or keep it going. Constant repetition of certain words or phrases. They may have difficulty expressing their desires or needs. They may fail to understand humor and take things too literally, which can make watching TV more difficult because they may not understand what's going on. They may use single words when communicating instead of full sentences and fail to understand simple questions or sentences. Or have slower processing at home as well as at school. It's important for caregivers to give someone who is on the spectrum more time to process what's been said to them so they can take it in, they can manipulate it, and they can understand what's been said. If we jump in right away and start restating it or answering for them, that takes away their agency, personal agency, and it's very disempowering. We want to give them a chance. In social interaction. They may fail to understand and respect other people's personal space, which can cause problems at home or at school. And we need to help them learn these boundaries. They may not understand why, but we need to help them learn that these are hard boundaries. Basically, they may have difficulty understanding other people's gestures, body language, reactions and feelings. Feelings and emotional intelligence is difficult for people who are neurotypical. And it can be more difficult for people who are neuro atypical. Not responding to one's name being called or a lack of desire to interact with other people. This could be the way they're wired. They don't have that desire to interact. Or it could be that interaction with other people is just so exhausting and so frustrating and so overwhelming that they just rather not. And one of the things that we can do therapeutically is to make sure that they do have positive interactions with people in a way that is not overwhelming to them. So they are more inclined to eventually develop an interest in select few other people. They may have difficulty making friends with kids the same age. Children typically tend to run and jump and play and be loud and go from thing to thing. You know, we know what kids look like on the playground. Well, for someone who is on the spectrum, that can be really overwhelming. And they may not understand exactly what's going on and they have a lot of difficulty. Young children Especially on the playground and when they're playing, may switch topics and switch what they're doing really quickly. We already know that people with autism have difficulty switching gears. Going from even the swing set to kickball could be very overwhelming to them. So they have difficulty making friends with children their own age because they process the world differently and they need more time to transition. They may avoid eye contact. Think about when you're sitting. You know, first couple of sessions you sat with a client in a room and you sat there and you stared at them in the eye and it felt overwhelming sometimes. And you're like sitting there looking at them going, do I look away? Do I look down? Where do I look? This feels invasive. Well, for people who are on the spectrum, it feels invasive a lot of times. And when people are looking at them, so they intentionally avert their gaze, because that is one way of destimulating themselves, for lack of a better word. They may not enjoy situations and events that kids usually love. Think about Chuck E. Cheese. That is overwhelming for me as an adult. I can only imagine what it's like for someone who can get easily overstimulated. And they may not show interest in other people's interests. They have difficulty stepping out of themselves and going, okay, I'm interested in whales, but you're interested in stamp collecting, so let me learn about stamp collecting. They don't see a point in that. Their interest is in whales, so that's where they're going to focus. And that is one of those challenges that we're going to talk about how to work with in a few minutes. Behaviorally, people may have repetitive movements, which is called stimming, and that often comes out when they start to feel stressed. They engage in some sort of repetitive self soothing behavior. They may be obsessively interested in one area or topic. And you'll find out in a few minutes that there are some gender differences here. They may play with toys in a repetitive way. For example, lining all the blocks all the time instead of building with them so you just have a line of red blocks and then a lot of green blocks. They may insist on a certain familiar routine order. They may have unusual sensory manifestations. They may sniff toys or people to find out about them. If they are oversensitive in their olfactory senses. They may get a lot of information about somebody by sniffing them. You know, you walk by somebody in the grocery store, you can tell if they're a smoker. You can tell what perfume they're wearing. You can if they're a painter. A lot of times you can get a whiff of paint off of them. So you can, you can tell certain things by certain people. Being hypersensitive to certain textures, sounds or lights, or being hyposensitive. Typically, more often the person is hypersensitive and that can be certain clothes. That can be high pitched sounds, low pitched sounds, repetitive sounds. We need to really break it down instead of just saying loud noise. Maybe it's loud treble versus loud bass or vice versa. And certain types of light. It may be different spectrums. They may not do well with the daylight bulbs and, and the broad spectrum. They may need the soft white and the more yellowy bulbs. So let's talk about some of this current research that was really cool. Serotonin, oxytocin, GABA and dopamine are all involved in the symptomatology of autism spectrum disorders. Serotonin is implicated in some of the issues with mood and sensory processing. Oxytocin is our bonding chemical and when that system is dysregulated, it makes people not interested in bonding with others. GABA is involved in emotion regulation and tactile hypersensitivity. And dopamine is your chemical that is involved in your perseveratory behaviors. I want to do it again. The dopamine is often high, which encourages people who are on the spectrum to be obsessively focused on one thing and just continue on and on. Interestingly, gut microbiota. Now remember a lot of our neurotransmitters, the serotonin, GABA, dopamine, etc. Are made in our gut and the gut microbiome, the bacteria in the gut have been implicated in the symptoms of mood disorders and autism spectrum disorders. There are over 100 million different bacteria in the gut, so there's not time to go into it in this particular presentation. But they have found with people with regressive autism spectrum disorder, they started out developmentally fine and then sometime after about two years of age they started regressing that. The antibiotic vancomycin has been effective at suppressing a particular type of gram positive bacteria called C Diff, which impacts dopamine levels. So it's interesting to note, obviously this isn't going to work for everybody, but there is a subset of people on the spectrum who may show communication and behavioral improvements with this treatment. Sensory integration training has shown significant effect in children who are on the spectrum. Sensory integration uses physical activities like slides, tossing, leaping, recreation therapy, physical therapy. It can be involved in either one of those leaping, using A balance beam, things like that, to train children's balance, communication and brain integration functions. When they're walking on the balance beam, they are figuring out their proprioceptive sensors, but then they're also figuring out how to use the words they need to ask for help for balance or whatever they need while exercising. Objects are often required to assist each other. A lot of times this is done with the clinician or with the parent, which promotes communication. So the person with autism is learning to communicate what they need and what they're feeling and what they're experiencing. Activities are selected for the individual that coincide with their particular presenting symptoms and conditions and abilities and hobbies in order to attract their attention and promote gradual recovery of communication skills. If you're working with someone who has absolutely no interest in race cars, then doing something with a race car track is not going to engage them at all. It's important to figure out what's going to work with that particular individual. Course symptoms may be manifested differently in females than males, and this is not definitive, but they have found that in a lot of females, their restricted interests, those things that they show that hyper focus on, may revolve around people oriented subjects like pop culture or literature. They may have fewer stereotyped behaviors and more socially acceptable interests. Often females develop coping strategies to manage social situations that mask the degree of their social isolation from peers. And they may demonstrate overt shyness or bossiness and perfectionism. And that may be part of the way that they cope with their level of stimulation. Being shy and withdrawn to prevent being overwhelmed or or being bossy. In order to control their environment, they may have evolved those behaviors as methods of coping and controlling their environment. For males, the biggest difference is that their restricted interests often involve objects like stamps or whales or something that doesn't involve a human being. So that's interesting in terms of noting that there are some gender differences in manifestation that can prevent early diagnosis and confound identification of concurrent diagnoses. Somebody may get diagnosed with conduct disorder or ADHD and the autism may be missed. So as usual, all of these hyperlinks link to the PubMed articles that can give you a whole lot more details. Major parent barriers or caregiver barriers include depleted parent resources. If a parent has to spend a lot of time at home with the person with autism, then they may not be able to maintain the same level of work that they did before. So financial resources, social resources. They may not have time to go out and hang with their friends like they used to. They may not have the Luxury of going to the gym like they used to because they don't have anywhere or anyone that can watch the person with autism. So parent resources, financial, social, environmental can be depleted. There's lack of specialized clinical and community support for parents. There's not a lot of talk. You know, there are certain specialized areas, especially in bigger cities, but in more rural areas, parents who or caregivers with people with autism, of people with autism often don't have a lot of support groups that they can go to or therapists who understand the unique challenges of living with somebody who is on the spectrum. Child dysregulation is a major barrier because it makes parents or caregivers not want to take the child out to the grocery store, to the shopping mall, to dinner, wherever, because the child seems to dysregulate without any forewarning. And that can make the parents feel sort of trapped in their own home. The need for excessive structure and sameness can really make a family's life very rigid in a lot of ways, which can be exhausting and frustrating and in some ways boring for the families. Lack of supportive programming available to children with neurodevelopmental or mental health disorders and medication side effects, especially fatigue. There's a much larger proportion of children who have autism spectrum disorders who are on atypical antipsychotics which affect their energy level as well as their appetite. Facilitators. For parents, though, let's not just talk about the negatives. Participation in specialized therapeutic options if there is therapeutic daycare, if there are respite centers that can even drop in, Centers where the parent with the person with autism can go. Adaptive community programs and schools that are knowledgeable about how to work with someone who has autism. So there are options for day camps and and play areas. The parents social capital, which means their social resources. Do they have friends and family that can assist them, that can give them respite, that can go to the store with them so there is somebody with the person with autism at all times? Effective parenting strategies include setting clear, often structural boundaries, which means visual Setting up charts, setting up stop signs, Anything that's visual that can cue the person in, planning ahead and previewing or role playing situations before they happen. That way the person knows what to expect. That can even include if they're starting at a new school, going to the school the day before or the week before, going to their classroom, sitting in their chair, doing all of those things. So there's nothing new, There are no surprises. Use positive reinforcement of positive behaviors and redirection of dysregulatory or behaviors that you don't want if the person is stimming. For example, one of the children that came to the daycare at one of my gyms used to have probably still does have autism. And when she would start to get overwhelmed before she would really start melting down and stimming, they would give her paper to tear and that was positive redirection. She wouldn't hurt herself, she wouldn't bang her head, she wouldn't do anything like that as long as she could tear paper. So that was positive redirection for her energy. Having fidget spinners and other things for people with autism to do with their hands to occupy themselves can be helpful for some Developing self efficacy by presenting healthy choices with constrained options such as okay, you have to eat a vegetable at dinner, would you like to have broccoli, corn, carrots, peas instead of saying what do you want for dinner? Giving them options to make sure that they have the ability to make some healthy choices and consistently review the consequences of choices if they choose not to eat their vegetables if there's going to be a consequence and reviewing that with them. So they start drawing that connection between if I don't eat my vegetables, then I don't get screen time tonight, for example, use role modeling during family activities to promote healthy habits like exercise, deep breathing, stretching, communication, those sorts of things. Almost one third of parents in this particular study extensively discussed the utility of therapy animals for establishing and maintaining healthy routines. And if they had a dog, the child would know that the dog is their responsibility. They need to get up in the morning because they've got to walk the dog, they need to feed the dog, they feed the dog and then they eat breakfast while the dog is eating. And they would correlate their different routines. They would walk the dog before bed and then they would go to the bathroom before bed. Having a dog in particular also increased healthy behaviors like exercising because they were walking the dog and they were getting up and moving instead of sitting in front of the TV or the computer. And having the animal was also a way to manage screen time for the for the person with autism, they could use screen time and say, okay, you can either play with the dog or you can be, or you can have screen time, or you can only have an hour of screen time, but then you can go play with your dog. Other skills focus on positive behaviors praising what is good. Be specific and don't praise only behaviors, but who they are. You know, just remembering to say I love you so much you are such an awesome little person or big person or whatever it is. Use positive discipline and redirection. We already talked about tearing paper. Have routines to ease transitions, such as if they're getting ready to do something, they can potentially have a mobile device that has a push notification that vibrates. The vibration cues them in that it is time to, you know, go to second period or get ready to go to recess or lunch or whatever they're getting ready to do. You can have songs that you sing. There are various different ways to cue the person in and get their attention to let them know, okay, we're beginning. Transition into this next activity. Encourage the caregivers to take the person with them during everyday activities. And you may have to scaffold at first, you know, instead of going to the grocery store at three in the afternoon on a Friday when it is crazy busy, go to the grocery store at 7 in the morning on a Tuesday or Saturday when it is not busy at all. So you're walking through the aisles. There's enough stimulation with different kinds of cereal and chocolate and food and sounds and lights and smells that they're going to. But once they get the hang of doing that, then you can start going when it's a little bit busier and if they do well with that, you know you want to praise that. And then you can start taking them with you to places where there's a little bit more activity. Select playmates with similar language and physical skills and invite only one or two friends at a time at first, making sure to have a zero tolerance policy for hitting, pushing and yelling. You can work get children who are on the spectrum together. They may understand each other a little bit better, but you can also get children who, you may have one children who has a autism spectrum disorder, who engages very well with other children who tend to be a little bit quieter or move a little bit more slowly or have a little bit more emotional intelligence and advanced empathy. Encourage play and reward good behaviors often and immediately. When something happens at the park, you know, reward it right then, right there. Don't wait till you get home and go, oh, I was so proud of the way you handled that slide incident. You want to praise it right then and right there. When Johnny comes down the slide, be down there waiting for him and go, that was so awesome. Role play or use comic strip conversations. And that's an actual tool. You can Google it to help the children learn social rules that others learn more naturally. With comic strip conversations, bubbles representing conversations can bump into or overlap one another to Illustrate Interrupting and thought bubbles can show other people's thoughts during conversation. People with autism often are better at understanding visual information and reading it than understanding what's told to them. And when you do it in comic strip conversations, it's going a lot more slowly than it does in real life, so it gives them more time to process. If they also have concurrent adhd, stick with that structure and routine that's really important for both conditions. Stay organized. Remembering that everything has a place. It can be a bin. It doesn't have to be, you know, micromanaged. You can have a bin for socks and a bin for shoes and a bin for action figures, that's fine, but everything has its place. Use clocks, timers and transitions. Simplify the schedule whenever possible. Don't over commit the child. Try to keep it simple and consistent. Have clear expectations and rules. You can use a three ring binder and create visual guides for, you know, you have a visual guide for going to grandma's house, you have a visual guide for going to church, you have a visual guide for going to the doctor that shows the child what to expect and what is expected of him or her. Have the person create a sanctuary space at home and wherever they spend a lot of time. That way if they start to get overstimulated, they know they have a safe space they can go to. And that safe space may be a corner where they put on their sunglasses and their noise canceling headphones for a minute. You may not be able to get super inventive with that in some circumstances, but, but at least they know that's a place they can go. Encourage movement such as fidgets or when they're sitting and doing their homework. Get a big stability ball instead of a chair for them to sit on. Ensure adequate quality sleep. This helps a lot with sensory issues as well as focus and emotional dysregulation. Ensure regular healthy nutrition even with picky eaters. So their body is getting the building blocks it needs to make the neurotransmitters that it needs to help them be as healthy and happy as they can be and maintain a positive attitude. Some days are really going to be awesome and some days are really going to suck and there are going to be a myriad of days in between. And it is important to remember to focus on the positive. Keep logs. Logs can be really helpful for parents so they remember and they can go back and say, okay, we did have the lion's share of the day. Yesterday was really good. We had one super explosive incident, but the other 23 and a half hours of the day were awesome. So, you know, they can draw from that instead of honing in on that one meltdown. Role. Play various social scenarios with the person. Trade roles often, and try to make it feel. Not all people with autism are going to be willing to engage in this activity, but if they are, then it is helpful to help them develop the social skills they need. Remember to choose your battles and be willing to make compromises. If Johnny really does not want to eat his vegetables tonight because, you know, the medication does interfere with their appetite occasionally, be willing to make compromises, but there's consequences. You know, okay, you don't have to eat your vegetables. I'm not going to make you sit here until they're all gone. But you can't watch TV tonight. You know, there are consequences. Sometimes you can make compromises over other things. Figure out which things are the most important battles to win, and figure out where you're going to be willing to wobble a little bit. That's difficult because that sounds contradictory. To be consistent, which it kind of is, you have to be consistent on the areas that you're willing to make compromises and consistent on the lines that you are going to hold solid in the sand. Make a list of everything that is positive, valuable, and unique about your child. Trust that the person can learn, change, mature, and succeed. And reaffirm this trust on a daily basis as you prepare for your day. So this is that positive reframing that we really want to encourage caregivers to embrace beginning every single day. Children on the spectrum do not necessarily provide the responses that trigger parents innate impulses to care for them. Some children initially don't respond much at all. Others have responses that we don't understand, and. And many respond differently every time the parent approaches. So it's just like, I don't know what to expect. Unexpected response styles create confusion and a sense of inadequacy in a lot of parents. They want to understand and they just, they don't. And they're like, there's got to be a clue in there somewhere. And sometimes there's not, or sometimes, you know, the child may respond irritably because they have a stomachache. But there was no way to know that. Remember that although children may not respond in a way that, as expected, they are still responding. Become a detective. Discover clues to triggers for the children's behaviors. Use backward chaining. Figure out, okay, oh, you know, he had soda at lunch today, so maybe the carbonation is upsetting his belly. Remember that their behavior is Communication, and it is functional in some way. They are either telling you they're overstimulated or they need help or they need consolation or something. Join children in their world. Require caregivers to imitate and follow. Don't make demands or ask the person to perform, saying, what color is this? Or what do the cows say? Which is what we do with a lot of children. That's directing the play. And the person on the spectrum is probably not going to respond strongly. Talk about what you and the child are doing without asking too many questions, like saying, boy, the designs in this carpet are really interesting. Or, you really like the sound of that block banging on the table, don't you? Or something like, it makes me really happy when you share with me. You are just narrating your experience. You're not asking for the child to have to communicate and. And they can choose to if they want to. Add to the play with your own creations in the hope that your child will someday become interested in you too. So if the child is playing with trains, then maybe you get a train and you start playing and try to engage the child that way. If the child has limited awareness of others, create situations in the play to get the child to notice you, such as if he's building with blocks. Build a complimentary section or ask him to help you do the same thing. How did you do that? Can you help me make a tower, too? Label the children's feelings so they can start developing an emotional vocabulary which will help them reduce frustration and let them develop their special capabilities. Keeping your expectations in check. There is a show, and I believe it is called Atypical on Netflix, I think, and it's a decent show if you can get past the mother's drama. But the adolescent in this particular show has autism, and he is very interested in whales and he loves whales. It's important not to say, okay, well, we've talked enough about whales. Let's talk about this. Let's let the child develop that interest in whales. Use scaffolding, such as going to the grocery like I talked about. Start out slow, where you're going when it's not busy, and then once Junior can do that, not get overwhelmed, not melt down the rest of the day, then maybe go when it's a little bit busier, and gradually introduce Junior to a active public place. Make sure to remind parents that they may have to endure a little suffering with their children so they can grow children. The person with autism, just like any child, is going to have to step outside their comfort zone. In order to grow. And whenever we do that, that's anxiety provoking. And it can prompt dysregulation either at that time or it can use up so much emotional capital for that child that day that the rest of the day is chaotic. They got through going to the doctor's or going to the grocery store, but the rest of the day, the child was having difficulty dealing with life on life's terms. Many children with special needs have problems with sequencing or processing auditory or verbal information. It's important to learn about the child's different ways of learning. Do they learn visually? Can they read it? Do they learn with their ears by hearing, telling them what to do, or do they learn kinesthetically? You've actually got to show them how to do it and have them walk through it themselves. And are they reflective or active learners? Generally, people with autism tend to be more reflective learners. They need more time for processing. To have that aha moment doesn't mean they are intellectually impaired in any way. It just means they need more time. Many children with autism take longer to register an interaction and decide how to respond. So learn to wait for the response before repeating yourself. If the child doesn't pay attention to what you're saying, remember to always use their name at the beginning so they know you're talking to them. Make sure they are paying attention before you ask a question or give an instruction. And this is true for children who aren't on the spectrum too. You want to call their name? I would call my son's name. I'd say, Sean, you know, look at mommy, you know, eyes on me. And then I would ask him to do something because he does have adhd and if I didn't get his attention, it was generally not going to go well. Making sure that you have their attention, use their special interests. And with people who are on the spectrum, they may not turn to look at you. You may have to go stand in front of them, you know, call their name, say, Johnny, you know, I need you to look at me. And if Johnny continues to do whatever Johnny's doing, going and standing in front of Johnny and getting down to that, to his same level. If he's sitting, you want to get down to a sitting position so you can make eye contact with him. Maybe where you have to start, use their special interest or the activity that they're currently doing to engage them. I can see you're having so much fun playing in the sandbox, but we have to leave in five minutes or you're making so many good choices today. I know it's been very stimulating. I bet you'll be happy to get home to pet Susie. My son, when he was little there were a couple of times, you know, we used the word stimulating a lot. And there was one day he toddled into my office and just announced to me very matter of factly that he was overstimulated and he popped his binky in his mouth and he toddled into his room and he sat down and just put himself into timeout basically until he was ready to come out. But you know, only a shrinks kid is going to be two and saying I'm overstimulated. But people can learn. It's not too early to start teaching that emotional vocabulary. If children find it hard to process what caregivers say, it's important to help filter out the less important information which can lead to overload and no further information can be processed. Get to the point. Not We've got a really big day today. We're going to do a bunch of things. First we're going to go to grandma's house. Start out with Good morning, we are going to go to grandma's house. Then we're going to go to the grocery, then we're going to come home and make dinner. Filter out all the other extraneous stuff. Get to the point. Pay attention to other sources of internal and external input. If the dog is running through the house, if the sister is packing for school, if dad is trying to make eggs or whatever and you're trying to talk to Johnny before school in the morning, that may be too overwhelming. You may need to go into a quiet space. Say less and say it slowly. Pause between sentences and requests to give the person time to process what you've said and think of a response. Don't use too many questions back to back. Ask one question, wait for an answer. Ask another question, wait for an answer. Use less nonverbal communication like eye contact facial expressions when a person is showing signs of anxiety because that can be overwhelming if you insist on continuing to get down and make eye contact, they may be averting their eyes for a reason. So you know, once you know you have their attention, it's important to give them the space they need emotionally and physically. Use visual support such as pictures and timetables and graphs and things, whatever. You know two year olds are not reading yet, so you're going to need to use more pictures than for older children where you may be able to use schedules if they struggle with open ended questions. Keep questions short and Ask only the most necessary questions, structuring them to offer options or choices. Instead of saying, are you hungry? That's a yes or no. You may say something like, did you enjoy your lunch? What did you learn in math today? Instead of how was your day? That's way too open ended. What did you learn in math today? If they don't ask for help, that's okay. You may give them visual help cards that they can use if they have a hard time asking for help, if they're disinterested in others and the caregivers. Encourage caregivers to get involved in groups that foster positive peer relationships and social development for the whole family and get interested in their interests. You know it's important. You're going to have to go to them a lot of times, at least initially. They're not going to come to you. When they take things literally, avoid using irony, sarcasm or figurative language and remember that they may ask a lot of questions. So when they do paraphrase to ensure that they are understanding what you're saying and have them paraphrase, you know, what did you hear me say? Or you know, you paraphrase their questions. Use good communication skills is what it comes down to if they tend to be frank, honest and matter of fact. Some people may interpret this as blunt or rude, and people who are on the spectrum don't intend to be rude. They are not emotionally callous, they just don't understand the same reciprocity. Instead of making a facial expression, you expect the person with autism to read and respond, to tell the person in a matter of fact but helpful way that their choice of words or actions was not appropriate and suggest a better way of communicating what they were trying to communicate. And if you've ever watched elementary, Sherlock's girlfriend had Asperger's disorder and you know, there's some debate whether Sherlock does. And they often have these types of discussions that are very frank and matter of fact. If they react badly when you say no, they may be confused about why you said no. If it's an activity they can do later on that day or week, show this in a timetable such as, okay, there's no park today because it's raining outside, but you know, pull up your weather app and show them on Thursday it'll be sunny so we can go to the park on Thursday. If it's a safety issue, look at ways of explaining danger and safety. If you are saying no because they're behaving inappropriately, a calm reaction with redirection may help decrease this behavior in time. If they're misbehaving at the park, you know you can tell them, okay, we are not going to go to get ice cream because you were choosing to push other children at the park and we've got to leave now because you chose to push children. So you're taking it back and connecting it with their choices. If it's something you've allowed before but you're not allowing now, explain the reason why it's no longer okay. If they ask for candy at 4:30 and you eat at 5, you say no. They can get very confused. You need to explain to them you can't have candy now because it'll spoil your appetite for dinner. You can have candy later or whatever it is, but you need to tell them specifically when later. Set clear boundaries and explain why and where behaviors are acceptable and not acceptable and what is expected of them in different situations. If they hit when they don't get their own way, keep a log to identify what is triggering or maintaining the behavior, including the antecedents. If they tend to be more physically aggressive when they are overwhelmed, when they are in public, when they haven't had a good night's sleep, when their blood sugar is low, you know, being a detective to figure out what may have contributed to that explosive behavior. Exploring what the benefits are of hitting. What was that person trying to communicate by hitting? And how can we teach them to communicate that differently? Help them identify what they're feeling and offer other ways of expressing no or stop such as the calm down couch. Instead of a timeout place, it's a calm down couch or sitting on a stability ball. If they're anxious or upset, they can bounce on that stability ball. They can get silly putty and use it for thinking putty and they can manipulate it. They can go into the drawing corner and draw out what they're feeling. Here's a picture of a little girl with a plastic cup that has tissue paper coming out of it. It's called a Dragon breather and there's a little hole in the bottom and she can exhale through it and you inhale and it's promotes deep breathing, slowing that breath and lowering that HPA axis activation. Punishing autism behaviors will not extinguish them. Understand what is driving the behavior and the early warning signs will help you and the person with autism cope or adapt. Remember to identify distress signals. Look for motivations for the behavior including sensory inputs and just exhaustion and reinforce positive behaviors in the moment. Bring with you a portable toolkit whenever possible. And if it's a person with autism, they can carry it with them too. You know they may be able to function independently. A timer for Transitions so if you're going to be in the store for 20 minutes, they can set their timer for 20 minutes. A schedule or activity book sunglasses a weighted lap pad or shawl noise canceling headphones A crunchy snack unscented hand wipes or a handkerchief A fidget toy of some sort that they can use for their hands. For other children, they prefer calming scents. So scented hand lotion, spritz, atomizer or sachets, especially essential oils of mandarin, lavender, cedarwood or frankincense have been helpful. And a tablet can be useful for certain games that require concentration, like Tetris. Helicopter parenting and free range parenting do not work because they prevent the child from growing. And frenetic parenting when parents frantically search for engaging therapies and activities can also overwhelm the child. So it's important to take a breath and focus on empowering the child who has different abilities instead of seeing them as somebody who needs to be treated like they're breakable or on the other end of the spectrum, not given enough guidance. Crave Remember stands for consistency in rules, routines and reactions responsiveness to individual needs and preferences attention for being lovable and for their positive behaviors validation of their thoughts, feelings and way of being in the world and empathy for how their sensory and neurological differences impact them emotionally, cognitively, interpersonally and physically. To help them become more mindful and mitigate or prevent triggers or unwanted behaviors, we need to help them figure out what those triggers are and what helps them them. And we can also help them develop the skills needed to engage in a neurotypical world so they can recognize potential danger situations ahead of time and figure out how to mitigate it so they're not overwhelmed like passing period at a high school. That can be really overwhelming for someone on the spectrum. There's a link to 10 tips on how to Communicate with Autistic People. You know, remember, I don't like putting the disorder before the person, but whatever. And then I have a ton of other references for you to look at if you are interested in finding out more about helping caregivers for people with autism. Are there any questions? I know I went through a ton of material today and you may need to go back through and look at the PowerPoint some, but hopefully you will find some of this useful and I will see you next week. Between writing notes, filing insurance claims and scheduling with clients, it can be hard to stay organized. That's why I recommend TherapyNotes. Their easy to use platform lets you manage your practice securely and efficiently. Visit therapynotes.com to get two free months of TherapyNotes by just using the promo code CEU when you sign up for a free trial at therapynotes.com. If this podcast helps you help your clients or yourself, please support us by purchasing your CEUs@Allce.com or or getting your agency to sponsor an episode. 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