Archive for March, 2012

A Question to the Reader

As a practitioner who works predominately with children who present with challenging behaviors, I spend a great deal of time talking to parents. However, I do not feel that I always communicate as empathically as I’d like, especially when it comes to discussing environmental factors (specifically choices by the parent in the home) that negatively impact their child’s functioning.

Due to my lack of subtlety, many parents appear fearful or judged (“I’t’s my fault…”). The bulk of treatment has to happen at home and in the community. Therefore, as a practitioner, I need a better way to talk with parents about identifying and reducing stressors in the home and identifying ineffective parenting strategies or styles and modifying them.

I need help… 

If you would (ESPECIALLY PARENTS), please share an example of when you felt alienated, judged, misunderstood, or made to feel guilty by a practitioner and how it effected your willingness to work with said person going forward. 


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Poker: Call the bluff

You’re holding a pair of aces in your hand and you don’t want the other player to know it. Your goal is to keep him betting, keep him raising. You want him to buy into your bluff so you can win his tokens.

In poker, the better you are at reading subtle facial cues (excitement, giddiness, satisfaction, hesitation, panic, lying, apprehension) the more likely you are to win the pot.

Poker Activity

1) Look up the rules of Texas Holdem’ (http://www.texasholdem-poker.com/beginnersintro). Print the rules out and review them with all participants (have them handy). Make rules simpler as you go if they seem too complex.

2) Print rank of hands  (http://en.wikipedia.org/wiki/List_of_poker_hands) for you and your partner to reference.

2) Optional: Briefly explain the concept of bluffing (youtube has a ton of great videos showing a good bluff).

3) Choose a Token to “bet” with: small rocks/marbles, Yugioh/Pokemon cards,  poker chips, m&m’s, etc.

4) As you play, tell the child when you can “read” his hand (“your smiling…that tells me you have a good hand..so i’m not going to bet”). Help him begin to identify what subtle cues look like (“your face looks nervous…that tells me your unsure of whether to bet or fold”). Ask him to do the same to you. Be obvious at first.

Enjoy the fun. I guarantee you and your child will laugh like crazy.

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This week and periodically throughout this blog, I will share a profile of a child on the spectrum. I do this as an attempt to highlight the incredible variability of the autism spectrum but also as a learning opportunity for myself. When you write about someone in such detail, you force yourself to look at them and the work you’re doing to help them in a more critical way.


Brian is 6-years old and as skinny as a bean pole. He has a big smile that he flashes often – mostly when he’s being mischievous. Brian was diagnosed with autism at the age of 4. Academically, he’s just slightly below grade level. He is extremely energetic, frenetic even, and has a difficult time regulating himself and more specifically, his body. It is rare that Brian is able to sit still for more than a few seconds at a time, unless he is tired or “dreaming”.

Brian has difficulty in many aspects of daily life. When verbally perseverating (ex: “Can i play, can i play, can I play..”), he becomes more and more dissociated from his environment, as if he’s dreaming while awake. His eyes appear unfocused and he seems to be unable to hear or see anything. During these times, Brian ussually begins a dance-like stimming behavior, with his eyes deeply focused on his index finger as it draws a figure eight in the air in front of him. It’s beautiful to watch. Hypnotizing.

Brian has difficulty controlling his body in space, which makes interacting with others a challenge, especially in more populated settings like the school lunch room. In such environments, he will jump or crawl on the ground while walking from one place to another. Its not uncommong for Brian to begin hitting himself (often in the head) in instances of sudden change, in an overstimulating environment (loud, unpredictable noises and too many visual cues), or when he is not given the opportunity to complete a routine. Following such episodes, Brian will appear frightened at his body’s lack of control.

Brian also displays a great deal of strengths. He has an incredible knowledge and interest in animals (which is how he learned the alphabet), very strong imaginative play, a sponge-like memory, and a persistent willingness to engage with others. Brian’s laugh is infectious, like a child being tickled, and gets him lighter treatment than some of his more mischievous behaviors often deserve.

Brian, like all children, has a unique profile. In writing about him, I can focus in on his strengths, address his challenges, and create more effective strategies for working with him going forward. I encourage all parents and practitioners to try this reflection exercise.

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Scenario: Kris is sitting on the floor playing with a train. She becomes excited by the sound of the train banging against the floor.  She repeats. As a parent, you notice her quickly becoming more and more activated. Her body’s moving quicker, she’s jumping, getting louder, less focused and less intentional with her actions. ASAP – use visual timer transition intervention*

Introduce Structured, Step-by-Step, Activity (simple, fun, repeatable, physical).

Example Activity: Toy Car Wash (“I need your help washing these toy cars, they are so dirty”). 

3 Simple Repetitive and Regulating Steps (using her body):

1)   Dip and scrub car in a small bucket of warm soapy water

2)   Rinse car in small bucket of warm water

3)   Dry car with dishtowel.

Afterwards: This is a great time for a rhythm building exercise**  to help child take her sense of balance and calm back into next spontaneous play activity.  

* refer to post on visual timers.

** Any exercise that regains the body’s natural rhythm: rocking back and forth while taking deep breaths, walking up and down the stairs while counting to 4, etc.

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Using Visual Schedules will do several important things for you and your child:

1. Provide predictability (I know what’s coming next), therefore reducing the anxiety of the unknown.

2. Provide a visual road map that the child can mentally reference throughout the day/outing (“after the swing we go see the fish in the fish pond”).

3. Something you can return to throughout the day that doesn’t rely on confusing or misunderstood language (“fish pond”, “swings”, “Anthony’s office”, etc.).

4. You will be communicating more effectively.Children on the spectrum often think more visually than verbally.

Materials Needed: Preferably a dry erase white board  and markers (paper and a pen will do just fine), some artistic ability:)

Example of a Visual Schedule I used with a young Client and his Father (dad’s verbal plan on left, child’s visual plan on right):

  • Overarching goal: working on improving transitions, reducing anxious response (tantrum) when out in the community.
  • Goal for Dad: feel confident setting limits and managing transitions without disruptive behavior.
  • Goal for Child: Successfully transitioning from one activity to the next, understanding the timer means “next activity”, and using the visual schedule as a mental map to reference throughout the day.



Recommendations for your first try:

1. Start simple. Try this on a short, enjoyable outing (ex: 45 minutes) that has minimal transitions (less than 3).

2. Use the timer to help your child through each transition (reference previous post on Timers) and reduce power struggles.

3. Create a short transition routine (ex: 3 claps, 2 deep breaths, say something like “transition” or “change”).

4. Use ridiculous amounts of praise at each stage of the outing.

Another visual example:

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