Autism

My son was diagnosed with Autism at the age of 2 years and 3 months.A month laterhe was onintensive one-on-one home-based therapy. By five, he was in a regular mainstream school, totally indistinguishable from his peers.

I soon found there was very little software available to teach children with Autism. This document outlines the information on Autism I have acquired over the years and the computer software I used to aidmy son'srecovery.

It is important to understand that without any Autism therapy or intervention, a child with Autism or PDD will absorb far less information and knowledge from the environment than a typical child. A typical child will start to talk at1.5 to 2 years with almost no help from his parents or siblings. He will then acquire around 6 new words a day and will have a vocabulary of an amazing 10,000 words before the age of seven. A child with Autism may become verbal much later and have poor language and social skills if he is not given speech and behavior therapy. At least initially, a child with Autism must be given a strong knowledge base i.e. he must be taught speech, language and age-appropriate behavior.

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Starting work with your child

If you even suspect your child has Autism or ASD, you must begin work with him immediately. Do not waste vital time waiting for a formal Autism diagnosis. I met one mother who waited six months for a formalAutism diagnosis before beginning any treatment. Imagine how much she could have taught her child in that time. You will find out for yourself that most doctors know very little about Autism and will simply recommendspeech therapy,special education or an early intervention center. The worst thing some d octors will do to a parent is to take away hope. You will acquire more information on Autismfrom other parents of children with Autism than you would from any general practitioner. As you work with your child and see the results, you will soon find other parents of newly-diagnosed children with Autismcoming to you for advice. Start working with your child now, even if it means just trying to communicate with him through play. This time will never ever be wasted. Even if tests show that your child does not have an Autistic disorder, you've lost nothing. Trying to teach achild with Autism at the table could be difficult at first, as the child may resist learning and lots of positive reinforcement and encouragement is vital. There are many structured teaching methods for children with Autism such as ABA, TEACCH, PECSand Greenspan to name a few. Many parents adopt their own, often very successful strategies for teaching their children at home.

Denial
Many parents will simply not believe their child has an Autistic disorderand will not even seek a diagnosis. Too often, they ignore theclear signs of Autism in their childand somehow hope hewill improve on his own.They often wait until it is too late to start work with their child. Some of the excuses I've heard are: "He looks fine - it's just the terrible twos", "My son started talking at five", "Einstein had Autism and he started talking at nine", "He'll just grow out of it" (and the list goes on...).

Autism diagnosis

Although an early Autism or ASD diagnosis for this potentially devastating disorder is critical,children with Autism rarely receive a diagnosis before the age of 3 or 4 years. There are no outward physical differences betweenAutistic kidsandtypical children - in fact most children with Autism are very good-looking. The only differences are behavioral. Autistic kids will exhibit at least some of the following:
Poor spee ch and language skills
Inappropriate play eg. child may continuously spin the wheels of a toy car rather than push it
May line up toys or other objects
Trouble interacting with others
Poor eye contact
Walking on toes
Hand flapping
Tendency to have narrowly focused and odd interests
Not asking for things in the same way as other children
Failure to show objects to others
Failure to orient to one's name being called
Failure to engage in reciprocal play where there is a back-and-forth between two people
Failure to copy others' motor movements
May not use pointing to direct another person's attention
May resist social touch such as hugging

Autism spectrum
A child with Autism can be anywhere in the broad Autism 'spectrum'. At the upper end, the child could appear almost normal and have few autistic traits. He may perhaps be the quiet child in the classroom with few or no friends a nd a couple of quirky habits. He may not even be diagnosedhaving Autism until much later in life. At the lower end of the Autism spectrum, the child would be termed low-functioning, have poor speech and language and would require much more intensive Autism therapy. No matter where a child is in the Autism spectrum, he can and must be helped.

PDD NOS and Autism
Pervasive Developmental Disorder or PDD is actually a bit of a misnomer. Many doctors who would not like to commit to giving a diagnosis of Autism will tell the parents that their child has PDD or PDD NOSwhen in fact the child is in the Autism or ASD spectrum.

Types of Autism
Some children are born with Autism while others develop the condition usually in their second year. The latter isknown as late-onset Autism.The childstarts life normally and gradually developsthe symptoms of Autism, losing speech and gradually showing more and more of the symptoms if Autism . If diagnosed and treated early withone-on-one therapy,Autistic children will show remarkable improvement, often to the point of being termed "recovered". This is where the child with Autism is indistinguishable from his peers.

Asperger's disorder and Autism
Asperger's disorder, also called Asperger's syndrome is a type of pervasive developmental disorder (PDD or PDD NOS) as defined by the American Psychiatric Association. Asperger's disorder is similar to high-functioning Autism in how it affects a child's mannerisms and socialization traits. A distinction between Asperger'ssyndrome and Autism is that young children with Asperger's often have normal language development, although the rhythm, pitch, and emphasis are irregular. Unlike Autism, Asperger's disorder does not delay other aspects of development; a child usually has age-appropriate self-reliance and an interest in the world around him or her. However, like Autism, children with Asperger 'ssyndrome have abnormal social interactions, facial expressions, and gestures. Asperger's disorder affects males 9 times more than females. Its cause is unknown. More research is needed to confirm whether Asperger's disorder is a condition that is genetically related to Autism.

Autism Therapy and Speech therapy
A common mistake is to assume that speech therapy is the solution to Autism. Speech therapy certainly has it's place in prompting and refining a child's speech and vocalization but it takes many hours a week of intensive one-on-one work to teach the child with Autism compliance, new concepts, language and age-appropriate behavior. A child with Autism will probably see a speech therapist for 1 or 2 hours a week. It takes a lot more work to get a child with Autism ready for school and to ensure he succeeds at school once he gets there. Once your child is in school, it would be wise to continue the speech therapy sessions. Some schools have a speech therapist that works with the children at the school itself. More on Autism and schools later.

Language is the key

The frustration of a child with Autism was once described as that of being in a maze where the walls are made of glass, trying to communicate with someone on the outside and only being able to bang on the walls. There is no doubt that much frustration and temper tantrums can be reduced and even avoided when communication and language is encouraged and developed. A typical child works out very early that it is in his own interest to acquire language whilst a child with Autism may not. He needs to be taught that language will get him results. On this point, if your child asks for something, give it to him immediately or at least respond to his request immediately. Ignoring him will certainly not encourage his speech.

When do I start to treat a child with Autism?

If achild hasAutism, t he clock has already started to tick even before any formal diagnosis. The most gains will be made when the child is in his very early years. Although children as young as 18 months are on Autism therapy,most are diagnosedafter 2 years of age and start treatment even later. Whatever you do, don't leave it until it's too late. Quite simply, the sooner you start teaching a child with Autism the better.


Autism treatment

Of all the therapies around for Autism,ABA (Applied Behavior Analysis) has attracted the most attention. The system pioneered by Dr. Ivar Lovaas at UCLA in the sixties is a teaching program that works on systematically removing the "traits" of Autism until the child does not satisfy the criteria for the condition. The system is very intensive but proven to be extremely successful in almost all cases of Autism. The Applied Behavior Analysis teaching system basically breaks down any task into subtasks and places a very high emphasis on rewarding the child for working well. There is no physical punishment at all in the system. Autism therapy starts off in a very rigid structured form but gradually takes the shape of a typical school environment. Those who know little or nothing about ABA may say it is too rigid and turns the child into a 'robot' by rote learning. This would appear so at the start but as the child learns to learn, he progresses to a point where he can join his typical peers in their learning style. Most parents who persevere with the program for two to three years can successfully mainstream their children. The results speak for themselves. The child usually begins school, attending regular classes with an aide. The aide is gradually 'faded' and the child blends in with the class. More on aides and fading later.An excellent piece of software is the "Discrete Trial Trainer" that uses the Applied Behavior Analysisprinciples to rapidly boost a child's language. We have this pr oduct in our range of software.

How many hours?

A question often asked is how many hours of behavioral therapy does a child with Autism need? There are many cases where a child with Autism needs up to 40 hours a week but of course, it depends on the level of severity of the child. A program usually starts with around 15 to 20 hours a week and can work towards 30 or more hours a week. Once a child with Autism is in school, the hours of work at home will fall back. Quality is of course, more important than quantity and energetic, dedicated therapists are vital to your child's progress.

Working with your child
I would strongly suggest the parentsbegin working with the child at least initially rather than leaving him to a therapist. Your child will trust you and understand you are trying to help him. You need to have boundless energy, be animated and genuinely love teaching your child. This is not easy and experts estimate you could do this for no more than 10 to 12 hours a week. If both parents take turns, the task is, of course a lot easier. Later, you could introduce a therapist or two to help out as you will not be able to maintain a high level of energy for too long. An advantage of doing the initial work yourself is that you will then know a good therapist when you see one and be able to weed out those that are of little value to your child.

Choosing a therapist
Choosing a good therapist for a child with Autism is not easy if you haven't worked with a child yourself. Many experienced parents will actually be able to train their newtherapists. Therapists can be anyone with enough energy, enthusiasm, patience and genuine love for children. Those below the age of 18 are often too young and immature (some will actually be frightened!). Mothers with children often don't have the time and energy and often don't like to be told how to deal with children as they feel they are the experts. One applicant told me how she regularly smacked her own children when they misbehaved. There is no room for such people in your home. A good tip is to make a short list of the ones you feel may be suitable and tell them there will be a training period of a couple of weeks during which there will be no payment. Many of them will drop out asworking with a child with Autismis very demanding and not suited to everyone.

Special Schools
Whilst there are many excellent special education schools around, sadly, many are under-funded, understaffed and ill-equipped to teach children with Autism. There is usually not enough one-on-one support for the child and worst of all, the child can pick up inappropriate behaviors from the otherAutistic children. I find all this heart-breaking as there is so much a child with Autism can learn in the critical early years.

Mainstream Schools

Your g oal should be to get your child into a mainstream school. Three years of intensive one-on-one work at home will go a long, long way towards successfully mainstreaming a child. Once a child with Autism is successfully mainstreamed you have won half the battle. I say this because it would be wise to continue working with him at home as well. You may need to educate the principal and staff on Autism and a good idea is for you or your therapist or consultant (if you have one) to do a short presentation. I would strongly advise liaising with your child's teachersto address any difficulties at school. You could use this feedback to work with him at home thus preventing him from falling behind. Obtaining in advance his school books and material they are going to cover at school is a good idea as you could work with these at home, reading them to him at night etc. so it is not all new to him at school. It is advisable to keep his home therapists as his school aides as they will know him a lot better than any school-provided aide. You need to discuss this with the school principal before he enters school. Once he enters school, you may need to begin with short hours eg. 2-3 hours a day and gradually build up to a full day.

Uneven skills
A child with Autism often has uneven skills eg. he may have very strong areas such as memorizing pictures or words and reading at an early age and weak areas such as making social contact with his peers. You need to firstly identify the strong areas. It goes without saying that you should use these strengths to the fullest advantage. For example if the child has strong reading skills, explore this to the maximum. Many ofchildren with Autism have very strong visual skills. Use pictures to stimulate and refine their language. If your child learns to read or write before he gets to school, it will be one less thing to worry about and he will have more time to learn other skills that he is lackin g.

"My child can't talk at all! Where do I start?"
A frantic mother of a child with Autism once phoned me with this question. Teaching speech to a child with Autism is done on a step-by-step basis. A child cannot run before he can walk. Before attempting actual speech, you can first teach a child to match identical pictures, then non-identical pictures i.e. matching a red car with a different-colored one. The next step is receptive language where the child is asked for the picture of eg. a cat, horse, house etc. (see next section). If your child can achieve receptive language or has already reached this stage, this is promising as he can at least understand what you are saying and this will ultimately lead to him expressing himself verbally. Do not be complacent though, as his vocabulary may be limited. You must do what you can to make sure his vocabulary is expanded as widely as possible.

Receptive language
This is w here the child understands what other people are saying. It is a major step in the progress of a child with Autism. It is however not enough for the child to understand just a handful of words such as food, milk, bike etc. A typical child of seven can understand and use at least 10,000 words. A child with Autism needs to have hisreceptive language boosted as early and as quickly as possible.

Receptive language software
The Discrete Trial Traineris a software package that allows you to use your computer to teach your child any number of labels and sounds. What happens is the screen displays from 2 to 5 images and the child is asked over the speakers eg. "Touch Eating". If the child correctly clicks on the correct image using the mouse or touch-screen, he is rewarded with a little animation. When one label is mastered, the program moves on to the next label, occasionally bringing in mastered labels to see if the child has remembered them. This CD has been extremely successful. You canset the level of difficulty and you get a visual report of his progress. With this packageyou can use it to teach categories as letters, words, shapes, numbers, colors, objects, body parts,actions/verbs.

Teaching with pictures
"A picture is worth a thousand words" and using pictures is an excellent way to teach speech, language and communication. Children with Autism are highly visual and can be taught almost anything using images. Temple Grandin, the famous autistic author of many books on Autism once said that she thinks in pictures. You need thousands of good photographic pictures to help with 'generalization' i.e. if a child with Autism has just one picture of a white dog and is taught this is a dog, he may not easily recognize a German Shepherd or a Rottweiler as a dog when he sees it. Using new and varied material also keeps a child from getting bored and frustrated. Minimize the number of stick images or drawings used. Actual color photographic material isbest as the images are more life-like and much easier for the child to relate to. You can never have too many pictures in your collection. Get them from anywhere you can - magazines, old books, the web, printed catalogs, even junk mail!

Printing from a CD-ROM
The falling prices of computers and color printers has created a trend away from buying expensive printed flashcards towards software such as our TeachingPix2CD-ROMthat contains many thousands of color photographic teaching images that can be printed from a home PC to a color printer at a tiny fraction of the cost. You can pay up to a dollar for each printed flashcard, whilst printing from our CD-ROM works out to around 1 cent per picture. Another advantage of using a CD-ROM with a huge range of pictures is that you can select and print what you need at any time. You do not need to print all the pictures right away. The images on the Tea chingPix2can have their labels switched on or off. You can print the images in sizes varying from 1 per page (biggest) to 8 per page (smallest). This CD-ROM with over 10,000 printableteaching images isour most popular product and is widely used to teach childrenaround the world.The images can be used in any teaching system such as ABA and PECS includingworking with Matching,Receptive language andExpressive language.

Printers
Modern color printers are not only a lot cheaper than they were just a few years ago, they can also printphotographic-quality prints onto ordinary (photocopy) paper and don't require special expensive paper. If you are printing thousands of pictures to use as flashcards, you may not want to print them on special paper. You need to be able to print photo-quality pictures to regular photocopy paper. If you already have a printer that needs special paper and you want to print thousands of pictures, it could be worth looking at getting a new printer. The new inkjet printers produce high quality text and images in black and white or color. Many of today's inkjet or bubblejet printers can print photographic images and laser-like text that come close enough to the quality of more expensive laser printers. I personally use a Canon inkjet although there are many other good-quality, yet low-priced models around.