Little Friends Center for Autism is an affiliate of Little Friends, Inc. Little Friends, Inc. is a non-profit, social service agency that services over 800 children and adults with developmental disabilities. Little Friends operates schools, residential, and vocational programs. Little Friends Center for Autism specializes in Evaluations Home programs/aba/basic S Training Consultations Therapy O.T., Speech Visual Training Systems Social Skills Groups Support Groups Counseling Information & Referral Walk In My Autism Cynthia Brouillard, Psy.D. Evaluation Clinic Director, LFCA Patti Boheme, M.S., LCPC Executive Vice President, LFCA Video 1
PREDICTABILITY CONTROL CHOICE Predictability Choice Control These factors are essential to our ability to function in our daily lives. Enable us to cope with stressors big and small Enable us to adapt and maintain a just right fit to our environment including the social setting and social expectations Enable us to get our needs met Enable us to remain organized in order to meet the demands of our daily lives Predictability + Choice = Control We use all sorts of embedded information to enable us to predict our world: Environmental Verbal/Auditory Visual including nonverbal communication from others Only 7% of emotional meaning is conveyed through words 55% of emotional meaning is expressed through facial, postural and gestural means 38% of emotional meaning is expressed through voice tone (Albert Merabian, Teach Your Child the Language of Success Duke, Nowicki and Martin) 2
Predictability + Choice = Control Information which enables us to predict cont. Our previous experiences provide a template for us to anticipate what is likely to happen in similar settings and situations e.g., we generalize previous knowledge to current events, expectations and settings Our brains enable us to be flexible in our thinking as most neurotypical folks can process multiple pieces of information rapidly, we can take individual pieces of information and see how they relate to a larger whole and can reorganize these pieces of information to fit a new framework in other words when things do not go as planned we regroup and make a new plan Choice We make choices throughout our day What we want to wear What we want to eat What we like to read or watch on television To attend or not attend events or activities We make our choices known both directly by stating our wishes and indirectly by refraining from participating, avoiding situations we dislike or feel uncomfortable with You wake up tomorrow and you have autism! 3
What does this mean??? Your ability to predict your world is hindered Things in your day just seem to happen Activities change rapidly and often before you are ready Your routines are altered without warning What people say and their actions do not always match Directions, information comes rapidly keeping up is difficult (processing time for sound in individuals with autism can be 20 50% longer than neurotypical people) Other people seem to constantly want you to do things, except you don t always know what they want or how to complete the task More Implications What you want and what you get may not be the same 14% of children with autism are nonverbal by age 9, 36% have some verbal communication and 40% have fluent verbal skills (Lord 2004) Use of gesture is also impaired in individuals with autism making your ability to make your needs known difficult The result is Frustration, Anger, Overload, Distress OVERLOAD Once on overload new problems emerge! Processing new information (especially verbal) becomes nearly impossible Sensory input seems exaggerated and intolerable My hearing is like having a sound amplifier set on maximum loudness. Temple Grandin Routines and rituals provide comfort and a sense of predictability, but those around you, while well meaning, do not allow it You cannot access the words you have expressive language skills are severely hindered 4
Getting Kids Grounded Visual systems are an effective and important method for getting individuals with autism grounded and organized Provide predictability which can reduce anxiety Enable those with limited verbal skills to have a voice Presents information in a manner which relies more on visual processing (often a strength) and less on verbal processing alone (a known weakness) Maintaining predictable routines is also important Triggers New Environments New people Environments with negative memories (for individuals who think in pictures, visual cues often trigger visual memories of previous experiences) Unanticipated touch or touch that they cannot control Loud environments or environments with unpredictable sounds 5
Little Friends Center for Autism, Inc. (630)305-6039 TIPS TOILET TRAINING by Patti Boheme, M.S., L.C.P.C. and Mary Crissman, B.A. TOILETING OFTEN BRINGS ON A GREAT DEAL OF ANXIETY BECAUSE: We have to teach it. It usually doesn t just magically happen! It is something the child can control. Becomes a rigid routine. Many parents get anxious about toilet training doctors, psychologists... Everyone seems to have different advice on how to do it, but how do you choose who is right! Being Toilet Trained is a Quality of Life Issue Needing diapers at 30 is not a good thing. Being toilet trained effects where a person with a disability will go to school, recreate, where they will live and possibly how they will be treated. Be consistent don t stop. 6
FOR SOME CHILDREN WITH CHALLENGES, BEFORE AGE THREE MAY BE TOO SOON DUE TO: Focus on communication LACK OF DRESSING SKILLS DELAYED COGNITIVE AND EMOTIONAL MATURITY DELAYED PHYSICAL DEVELOPMENT BUT IT IS HELPFUL TO CHANGE THE CHILD IN THE BATHROOM, HAVE THEM SIT ON THE TOILET, AND ATTEMPT TO VOID SO THEY ARE NOT AFRAID Everyone doing the program needs to do it the same, including dad, mom, grandma, aunts, uncles, etc. Everything should be the same from pulling down pants to the hand-washing routine! IF SOMEONE VARIES A STEP, WHAT DO YOU THINK WILL HAPPEN? MAKE SURE YOUR CHILD DOES NOT HAVE ANY MEDICAL CONDITIONS THAT WOULD CAUSE PROBLEMS WITH TOILET TRAINING IF YOUR CHILD IS CONSTIPATED, WORK WITH YOUR DOCTOR TO ALLEVIATE THIS PROBLEM BEFORE BOWEL TRAIINING 7
SYMPTOMS SOLUTIONS Leakage Increase fiber and fluids, exercise, see Irregularity doctor Digging Medication (ex. Miralax). Smearing bloating Problems urinating Withholding Going often but a small amount, hard stools Behavior problems Children with autism have more constipation issues and eating problems than typical children (Mayo Clinic Research) It can be helpful to chart when the child is wet and has a B.M. throughout the day to determine how often they should be taken to the bathroom. Chart for at least 5 days including a weekend. Also chart what they eat and drink. SAMPLE CHART 8
PATTERNS EMERGED Child has B.M. most mornings 30-60 minutes after breakfast Child dry 1 ½ - 2 hrs at a time Child urinates 30-60 minutes after snacks, meals, drinks PULL-UPS ALONE ARE NOT GOOD TO USE DURING TOILET TRAINING AS THEY FEEL TOO MUCH LIKE A DIAPER AND THE CHILDREN DO NOT FEEL WHEN THEY ARE WET. Pull-ups can be used if you put underpants on under the pull-ups. Training pants and plastic pants also work well. Change your child often so they get used to feeling dry and prefer that sensation. POTTY CHAIRS MAY BE HELPFUL FOR VERY SMALL CHILDREN BUT MANY CHILDREN HAVE A DIFFICULT TIME SWITCHING TO THE BIG TOILET. If possible have children use the regular toilet right away. Adapted toilet seats can be used and are helpful for small children. Children sitting on the toilet need to feel comfortable and secure so having them place their feet on a step stool may help to stabilize them. 9
Magic Twelve Inches For children who are diaper trained Children who will only go in a diaper, put them in underwear and give them their diaper to use but only in the bathroom. Have them stand closer and closer to the toilet to use the diaper. Use tape to mark off where to stand. Eventually they will sit on the toilet w/ diaper on. If necessary cut a hole in the diaper that gets bigger over time till it disappears! Little Friends Visual Toilet Training Program Review picture ring as a story before you take the child in the bathroom for about one week. When in the bathroom show the toilet pictures but do not talk instead use physical prompts to guide the child. 10
Toilet Reward Card with Choice Board (reward used only for toilet training) 11
Dirty Pants No Reward Rule Cards Basic Procedures 1. Baseline/chart 2. Set toileting schedule 3. Verbally review picture ring outside bathroom. 4. Follow schedule, have child give toilet picture and proceed to the bathroom 5. In bathroom use least restrictive prompt using visual picture ring, do not verbally prompt child. 6. If child is dry and urinates or has B.M.= reward. If child is dry or urinates only, verbally praise but no special reward. 7. Reward should be something the child loves and only gets for toileting. 12
Remember! When in the bathroom show the toilet pictures but do not talk instead use physical prompts to guide the child. 13