Wednesday, July 28, 2010

Sleep Tips & Tricks for Children with Autism

When running an Applied Behavior Analysis (ABA) program, parents find that they have many balls to keep in the air at the same time. In the midst of tracking behaviors, scheduling sessions, and thinking up new reinforcers, the more mundane aspects of life tend to go unnoticed. Things such as diet, exercise, and sleep often get pushed to the side because they seem like less urgent (or more difficult) issues to tackle. Think how you feel when you are deprived of sleep - cranky, lethargic, irritable, unable to think clearly. When you see an increase in your child's negative behavior or inability to focus on certain tasks, ask yourself how he or she slept over the last few nights.

It is common for children on the autism spectrum to experience difficulties falling and/or staying asleep. Below are some tips to increase the likelihood of your child getting a good night's sleep. If you already consistently implement these suggestions, but your child continues to experience sleep issues, speak with your ABA consultant for additional strategies. A good ABA consultant should be able to provide you with a behavioral plan to deal with issues such as bedtime tantrums and night awakenings. In addition, an excellent resource is Sleep Better!: A guide to improving sleep for children with special needs by V. Mike Durand.

Exercise at the right time:
There is a fair amount of research that documents the positive relationship between exercise and sleep. Be certain, however, that your child has time to calm down before bedtime. It is generally recommended that intense exercise (or playing, in the case of children) should end at least 1-2 hours before bedtime. While this is not realistic for some children, it is a good idea to institute some quiet time before the bedtime routine starts. Exercise raises the body temperature and it takes the body several hours to cool down to the temperatures associated with comfortable sleeping.

The sleep environment:
In order for your child's body to adapt to going to bed at a reasonable time, the environment needs to be conducive to sleep. The room should be quiet, dark, and cool. Remove any toys, books, or games that may tempt your child to get out of bed. The extra hours of sunlight during the summer can cause problems for some children, so consider making the room dark by artificial means, such as drawing the curtains or hanging a sheet over the window. Depending on the outside temperature, cracking a window, or turning on a fan or air-conditioner can help maintain a cool bedroom environment.

Be sure that the mattress and pillow are comfortable and free of allergens, such as goose down.

Establish a bedtime routine:
Human beings tend to be creatures of habit. Throughout our day, there are environmental cues that prompt certain actions and feelings. When the sun rises, our bodies begin to wake for the day. When we smell dinner cooking, we start to get hungry. We often go through a consistent routine in the morning - shower, get dressed, eat breakfast, brush our teeth. Why should bedtime be any different?

Start the bedtime routine at the same time each night and follow a consistent routine. Whether you choose to include a bath, brushing teeth, changing into pajamas, storytime, or songs - or all of the above - be consistent with the activities you include and the approximate duration of the routine. Taking a special stuffed animal or doll to snuggle with each night in bed can also help to cue sleep.

Waking up:
Consistent wake up time is just as important as a consistent bedtime. In order for the body's clock to be set, wake your child up at the same time on both weekdays and weekend days. Allowing your child to sleep in will affect his or her ability to fall asleep later that night.

Research shows that eating a large meal within 2 to 3 hours before bedtime can cause disruptions in falling asleep. In addition, eating spicy foods can cause heartburn, which could cause night awakenings. Consider serving a light meal for dinner, avoiding heavy sauces, fatty foods, and an overabundance of sugar.

Sugary or caffeinated drinks should be limited during the day and particularly before bedtime. Many children who drink a lot of fluids in the hours before bedtime are often wakened with trips to the bathroom. Caffeine is abundant in chocolate and many sodas. In some instances, caffeine can stay in the body for up to 12 hours, affecting the body's ability to relax for bedtime.

Limit media time:
Not only does watching an excessive amount of TV and playing video games take away from time engaging in imaginative play, physical activity, and engaging with family and peers, but research shows playing video games can increase respiratory and heart rates, and blood pressure. These physical changes can affect the body's ability to enter into deep sleep.

Experts recommend that televisions and computers are not used in the bedroom. Make the bedroom a sanctuary for sleep so that entering the room in the evening cues feelings of tiredness.

As mentioned above, the important aspect is to implement these suggestions consistently. It will take some persistence to make these changes, but the result is often a child who is well-rested and exhibits less negative behavior.
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Monday, May 17, 2010

Car & Air Travel for Children with Autism

As summertime approaches, families are thinking about where to spend their vacation time. For many parents, however, the mere thought of traveling by airplane or car to a far-off oasis causes them to break out in hives. Many children with autism have difficulties sitting for long periods of time. Accompanied with unpredictable transitions, particularly in unfamiliar surroundings, this can lead to a very unpleasant journey for everyone involved.

Airplane and Car Travel

There are several steps that can be taken to prepare your child for an airplane flight or a long car ride. We recommend starting to work on these suggestions a month or two in advance of the trip:

1) There are many books and videos available that show air travel from a child's perspective. The Good Little Traveler website has a wide selection of preparation tools, books, toys and games, and videos.

2) The TSA website dedicates a page to Traveling with Children with Disabilities and includes many helpful suggestions.

3) If you live near an aviation museum or know someone that has connections to the airline industry, arrange a visit to allow your child to experience sitting on an airplane and viewing the cockpit. If you live in Utah, take a trip to Discovery Gateway in Salt Lake City, where your child can sit in a real helicopter, or to Hill Aerospace Museum. Take a trial run to the airport, watch the planes take off and land, take the shuttle bus, and identify any problem areas that may need to be worked on at home before the vacation.

4) Many parents find that airplane travel is often more successful if they choose to fly during times that there child would typically be taking a nap or falling asleep for the night. If possible, pick and choose your flights to coincide with these drowsy times.

5) Stock up on plenty of your child's favorite toys, treats, and books. Restrict access to these items for at least a week before the trip so that they are novel reinforcers once travel time arrives.

6) Visit the public library to borrow several new books or DVDs for the trip, or pick up a new coloring book. These novel items are more likely to capture your child's interest for a longer period of time.

7) While we are not proponents of excess time playing video games, having a handheld game can make the minutes and hours fly by. If you are traveling by air and your child will tolerate them, buy a pair of earphones/buds for the device so that you and the other passengers are not bothered by the sound of the game. You may need to teach your child to wear earphones/buds for a longer period of time.

8) Work to increase the amount of time that your child can sit before needing to walk around. Set up chairs to simulate an air plane seating arrangement, with 2 to 3 chairs in your aisle and chairs directly in front of you. To start, determine how long your child will typically sit while being entertained by books and toys (use toys that you plan to bring with you). Next, require your child to sit for approximately 15 seconds less than this baseline time. Once the time is up, initiate standing up and walking up and down the "aisle", paired with plenty of praise and other effective primary (food or drink) or secondary (toys and social) reinforcers. It is important that you are the one to initiate standing up so that your child learns that he/she cannot stand up whenever he/she wishes. As your child is successful, gradually increase the amount to time that he/she is required to sit before standing up by 5 to 60 second intervals. While sitting, be sure to provide your child with activities such as books and toys.

9) Social stories can be an effective way to prepare your child for air or car travel. Put together a social story, using photos from Google Images, that shows the different steps of your trip (e.g., packing a bag, driving to the airport, checking in, going through security, etc.). Place the pictures in a small photo album and use them to help your child to anticipate the next step on travel day.

10) If you are currently running an Applied Behavior Analysis (ABA) program with your child, speak to your consultant about customizing your preparation to meet the unique needs of your child.

Keeping track of your child

If you are concerned about your child's ability to stay with you, particularly in large crowded places such as the airport or Disneyland, consider using a device such as the one offered by Securatrac. This device is available for purchase or can be rented by the day for a very reasonable price. It uses GPS technology and your mobile phone to locate your child and report it back through the SecuraTrac network. This type of safety net can provide you with piece of mind that if your child does wander away, he/she can be quickly located and found.
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Wednesday, April 21, 2010

Reinforcement in ABA Programs for Chlidren with Autism

Why do you continue to play with your kids, read your favorite magazines, make your family's best-loved meals, and talk about cherished memories with old friends? It's really a straightforward answer - because it makes you feel good. As much as we like to tout our "smartest primate" status, human beings are really quite simple creatures. We are much more likely to continue doing something that we find enjoyable than something that doesn't bring any emotional or monetary payback. Think about this. If someone gave you the choice of working 40 hours per week versus 20 hours per week for the same pay, what would you choose? Unless you are a workaholic with no hobbies or family (or you have a job that satisfies you more than all of these things combined), you are far more likely to choose the 20 hour option. Kids are no different. When they engage in an activity that brings them inherent joy or pride, they are likely to continue engaging in that activity.

However, life does not always provide us with fun, preferred choices. We all have responsibilities, whether it's completing a project at work, dealing with four loads of laundry, or practicing our times tables. As Denzel Washington says, "You do what you have to do so you can do what you want to do." Who knew he was a behavior analyst at heart? As our clients have heard us say multiple times, ABA (Applied Behavior Analysis) is not a method that is employed exclusively in an instructional setting. Rather, it is a waking hours approach. While this philosophy applies to many different behaviors and circumstances, this post will focus on the use of reinforcement.

Reinforcement is the most important skill for parents and instructors to learn. It is the “gas” that makes the program go. Consistently implementing effective reinforcement will maximize your child’s rate of acquisition of new skills and help to reduce behaviors that interfere with learning (e.g., poor eye contact, inattention and gazing, attempts to escape, verbal protests, tantrums). Unfortunately, it is the hardest component for parents and instructors to consistently implement over time. Maintaining effective reinforcement requires effort. Each individual team member must constantly assess the effectiveness of rewards that are used, change up the rewards offered, vary the presentation when using the same reward multiple times, and continue to come up with new ideas daily.

What are the goals of reinforcement?

➢ To make learning fun.
➢ To increase/maintain the child’s motivation to learn.
➢ To increase/maintain the child’s effort (i.e., a high rate of quality responses)
➢ To decrease undesirable behaviors that interfere with learning and functioning appropriately.

While these goals seem logical, you may wonder how to actually implement effective reinforcement. Here are a few guidelines:

➢ Provide rewards immediately following the correct response or desired behavior. This makes it clear to the child what behavior is being reinforced.

➢ Select rewards based on the individual preferences of the child. While some children may enjoy blowing bubbles, other children may find the texture of the bubble liquid aversive.

➢ Vary the type of reward offered from trial-to-trial to prevent satiation: Tickles, chair rides, bubbles, songs, reading a favorite book- don’t repeat the same reinforcer continuously. If someone tickled you each time you did something correctly, you'd probably feel an urge to punish them in some way.

➢ Make the presentation of the reward part of the reinforcement. A frequent mistake is just handing the child a toy and expecting the child to figure out how to make it fun. It is the instructor’s job to exert mental and physical energy trying to come up with different ways to make these items enjoyable to the child.

➢ When teaching new skills, use the procedure of Differential Reinforcement – High quality responses receive high quality reinforcement, and low quality responses receive low quality reinforcement. Typically, we rate rewards on a scale of 1-10 (ten being the highest value and 1 being the lowest value to the child). The child’s best consistent response should consistently earn a level 10 reward. When the child’s response is lower than their best consistent ability (e.g., Child requires a partial prompt and their best consistent response is an independent one), the instructor should decrease the value of the reinforcement proportionately (e.g., drop from a level 10 to a level 7).

➢ Instructors and parents should proactively come up with new reinforcers. If the child is unmotivated, he/she is less likely to complete the task. The child is not “bored” with the programs, but with the reinforcement.

➢ Evaluate the effectiveness of all reinforcers implemented, and make adjustments accordingly. Remember this rule: You will not know if something is reinforcing until after you see the child's reaction. Were they engaged by the reinforcer? Are they looking for it to continue?

➢ To avoid confusing the child, rewards for correct responses should be easily distinguishable from corrective feedback for incorrect responses. For example, do not give an informational "no" in a playful voice when the child responds incorrectly. By the same token, you should not give verbal praise with a lackluster tone of voice.

Assessing the effectiveness:
Make sure what you offered for reinforcement matches the quality earned. If you have a hard time finding rewards that the child is motivated to work for, assess what occurs between learning sittings at the table. Often, the problem is that the child is receiving higher rewards for "free" during structured play time. When faced with this situation, instructors should direct the child to less preferred activities/toys/food and save the more preferred activities/toys/food for rewards at the table.

For a comprehensive list of reinforcers and our "Reinforcer of the Week", please head to our website.

We would love to hear your ideas on reinforcers that have worked for your child or children you worked with. Please feel free to leave a comment under this post.
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Wednesday, April 7, 2010

Exercise & Autism

Exercise. We all know we should do it, but manage to find dozens of reasons to avoid it. I don't have the time, I'm too tired, it's too cold outside...Do any of these sound familiar? However many excuses we come up with, the facts remain the same. Exercise is proven to improve mood and prevent depression, combat chronic diseases, help you manage your weight, boost energy levels, and promote better sleep. These benefits are not just allocated to adults. Children can also reap the rewards of an enthusiastic playtime outside, whether it comes in the form of riding bikes, jumping on a trampoline, or playing tag.

When the NFL launched NFL Play 60 in 2007, they encouraged kids to get at least 60 minutes per day in order to promote good health and to tackle the rising problem of childhood obesity. With the rising popularity of video games and the draw of the television, kids are spending increasingly more time involved in sedentary activities. Knowing what we know about exercise and energy levels, this trend is counterintuitive to common sense.

For children with autism, the effects of exercise can be more meaningful than avoiding illnesses, increasing energy levels, and improving sleep (though these are all important, too). Several studies have documented decreases in intensity and frequency of self-stimulatory behaviors following bouts of rigorous exercise. These effects were relatively short - 45 to 90 minutes - but profound. Children that engaged in exercise were better able to focus on tasks immediately following the exercise intervals. While these studies are not numerous, they point towards a field of research that should be explored further.

That being said, we understand that sometimes it is just easier to switch on the video games or television. It is not always possible to drop everything you are doing to step outside for some playtime. Luckily, research shows that exercise does not need to be done all at once in order for the participant to reap the benefits. Instead of finding a 60-minute period of time to exercise and play outside each day, break that time up into manageable 15 minute intervals. Riding your bikes around the block a few times or playing a game of shadow tag in the backyard is likely to boost your child's mood (and your own) far more than watching another episode of Penguins of Madagascar.

Here are some ideas for working exercise into your child's life:
- riding bikes
- jumping on a trampoline
- playing tag
- rollerblading
- playing soccer (or just kicking the ball around the yard)
- playing catch
- swimming
- running on a treadmill (older children)
- riding a stationery bicycle (older children)

This list is just the tip of the iceberg. We would like to hear your ideas. Please leave a comment to tell us how you incorporate physical activity into your child's life.

In Utah, there are a couple of organizations that provide opportunities for children with disabilities to be involved in outdoor activities. If you do not live in Utah, contact your local autism or disability support group for resources.

In Utah:

Splore: "Splore is a Utah based non-profit organization that specializes in promoting empowering experiences in an active friendly world through affordable, customized, inclusive recreation and education programs for people of all abilities."

National Ability Center: The National Ability Center (NAC) is committed to the development of lifetime skills for people of all ages and abilities by providing affordable outdoor sports and recreational experiences in a nurturing environment.
NAC's summer camp registration is open. If you live in Utah, be sure to check out their schedule.


Freeman, S.K. The Complete Guide to Autism Treatments: A Parent's Handbook: How to make sure your child gets what works! 2007. SKF Books, Langley, B.C., Canada.
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