Ep. 14: Introduction to Behaviour Analysis
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Let’s Talk About Autism Part 2 (Episode 5)

In Part 1 of our series on Autism Spectrum Disorder, Cynthia and Bethany discussed what it might look like when someone has autism, and what the criteria are for someone to get diagnosed with ASD. Please be sure to listen to part 1 before listening to this episode.

In Part 2, they continue their discussion by looking at some things that can be put in place to help people with autism. They can also be helpful for people who do not have an Autism diagnosis.

Many of these strategies will be useful for kids with or without a diagnosis.

Some of the things they talk about are:

  • Using pictures to communicate
  • Visual schedules and routines
  • Sensory-safe spaces
  • How the being on the land can help

References

Kidder, J. E., & McDonnell, A. P. (2017). Visual Aids for Positive Behavior Support of Young Children With Autism Spectrum Disorders. Young Exceptional Children, 20(3), 103–116. https://doi.org/10.1177/1096250615586029

Knight, V., Sartini, E., & Spriggs, A. D. (2015). Evaluating visual activity schedules as evidence-based practice for individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders45(1), 157-178.

Public Health Agency of Canada, (2018, March 29). Public Health Agency of Canada Releases First-Ever National Autism Spectrum Disorder (ASD) Statistics. https://www.canada.ca/en/public-health/news/2018/03/public-health-agency-of-canada-releases-first-ever-national-autism-spectrum-disorder-asd-statistics.html

Schaaf, R. C., Dumont, R. L., Arbesman, M., & May-Benson, T. A. (2018). Efficacy of occupational therapy using Ayres Sensory Integration®: A systematic review. American Journal of Occupational Therapy, 72(1), 7201190010p1-7201190010p10.

Williams, M. S., & Shellenberger, S. (1996). How Does Your Engine Run? Leader’s Guide to the Alert Program for Self Regulation (1st ed.). TherapyWorks, Inc.

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This podcast is produced with the support of the Cree Board of Health and Social Services of James Bay and Jordan’s Principle.

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TRANSCRIPT: Let’s Talk About Autism Part 2 (Episode 5)

Cynthia Miller-Lautman

In part one, we discussed what autism is and how it is diagnosed. It is really important that you listen to part one to get more detailed information on what autism is. In this episode, Part two, we will talk about the strategies that may be useful for people with autism. They may also be helpful for people who have not yet had a diagnosis of autism.

These three strategies we will talk about might be helpful with all kids, with or without a diagnosis, so no need to wait for a trip south before trying some of these things at home. Try these out and see if they help. Today, I am so happy to have Bethany Hartropp with me again. She’s an Occupational Therapist from our DPSS team.

Bethany Hartropp

Waachiyaa Cynthia. It’s nice to be here.

Cynthia Miller-Lautman

So, Bethany, let’s get right in here. Let’s talk about some of the best things that we can put in place that may help someone with autism, either in their home life, community life or at school. I’m going to list them first, but we’ll spend the next little while during this podcast talking about these things. So what we’re going to focus on today is visual schedule routines, visuals and sensory safe spaces. Bethany, could you please start with describing what visual schedules or visual routines are?

Bethany Hartropp

Right. So a visual schedule routine is well, a routine is a really good place to start for any child or adult. The world can be a very stressful place when you don’t know what’s coming next. And this can be especially difficult for someone with autism to cope with. Because autism often causes a need for sameness and a routine helps us feel more comfortable in the world.
For example, most of us have the same morning routine each day. So routines help people with autism feel more comfortable at home, at school, at work, and a schedule for the day is good so that the person can be ready for what is about to happen. And pictures are the best way to show the routine and schedule, as many people with autism respond better to pictures than words.

This is called a visual routine or a visual schedule. And this can be super simple. It can be a piece of paper on the fridge with the day’s visual plan or the schedule. It can be a picture of school and a picture of hockey, then dinner and bed. Very simple. There, a picture calendar for the day. We can also make a visual schedule for anything that the child or family member with autism has trouble with.

For example, getting dressed. So I would draw, say, four boxes in a row and in each box I would draw a step that the person is going to do. The first box would be putting on underwear.

Cynthia Miller-Lautman

So you would just draw a picture of underwear.

Bethany Hartropp

So it could be underwear or a stick picture of a person putting on underwear. And then the next picture would be stick picture of the person putting on pants. Next box would be a stick person putting on a shirt. And then the next picture would be the reward that they get at the end. So that would be, for example, iPad time, for having done all of the things that they need to do.

And it doesn’t matter about the excellence of the drawing. I’m a terrible drawer. I really like stick pictures. And because many people with autism find pictures easier than words to understand, even if the pictures are really terrible.

Cynthia Miller-Lautman

And then you can you walk me through. So you’ve drawn these four pictures out your underwear, your pants, your shirt, and then the tripod. Can you walk me through how would you start using this routine with someone with autism?

Bethany Hartropp

So let’s take these. The getting dressed. Firstly, I would choose my moment. If this is the first time that I’m doing the getting dressed, teaching with the child, I wouldn’t want to be doing getting dressed, teaching in the morning when the bus is coming or when we have to run out to daycare. This is not a good practice time because everybody in the house is going to be stressed, including me.

So the best time to practice something is when we are relaxed and we have time to do this and there’s time for a bit of when there’s practice time. So for example, we could try Saturday morning if we’re not rushing out to do something else, that might be a good time.

Cynthia Miller-Lautman
That makes sense because you need to, if I’m understanding these four steps, he doesn’t get his iPad until he completes all three steps.

Bethany Hartropp

To say this is a six year old who’s learning to get dressed. I would point to the picture of the underwear and then point to the underwear and saying, “put on your underwear, please”, and wait for him to put on his underwear. And if he doesn’t do it, I would repeat it again, point to the picture and point to the underwear.And then if he doesn’t do it, then I would help him put on his underwear.

Cynthia Miller-Lautman

Bethany so that means you have to get him to put on his underwear before you move to the next step?

Bethany Hartropp

That’s right.

Cynthia Miller-Lautman

Okay. So I don’t get to say, oops, he really doesn’t want to on his underwear. So if it’s on that schedule, you now have to follow through.

Bethany Hartropp

He has to. That’s right. He has to follow through. And most importantly, I have to follow through.

Cynthia Miller-Lautman

Right. As the parent. Right.

Bethany Hartropp

I have to follow through. And then the next step was put on pants. So the same thing. Point to the picture. Point to the pants. Put on your pants, please. And with repetition, the person gradually learns that pointing to the picture and pointing to the object like there’s an association, there’s a link that is made between the two and then put on your shirt.
Please. Point to the picture and point to the shirt. Put on your shirt, please, and then get to the iPad. Most children will be able to do three or four steps and then get that iPad. If that many steps are too difficult or it’s a very challenging time, then maybe one step and then iPad and do that with a lot of success and then add in a second step and then iPad.

Cynthia Miller-Lautman

So I’m repeating what you’re saying, so if I have a child that’s really young and doesn’t quite understand to follow multi steps, you would do one thing, then they get the reward. And the same thing would be if I have an older child that’s really, really has a lot of difficulties following a routine and might be angry and not want to do it and try to run away. I would then start with one step, then they get the reward and grow it from there.

Bethany Hartropp

I like that idea. Your expression. Grow it.

Cynthia Miller-Lautman

So if anyone listening to this is interested, we have a blog post on our website about routines and how to make visual routines. You can check out that post on our website at Disability Programs Specialized Services dot org. It’s also listed a link to it in our show notes at the end of this episode.

Bethany Hartropp

Cynthia, you mentioned when you were making that list at the beginning, you mentioned visual communication strategies which are not the same as visual schedules. Could you please explain what these are and how they’re different from visual schedules?

Cynthia Miller-Lautman

Yes. So, Bethany, you just describe visual schedules, which is a schedule of a few pictures in a row that they have to complete. Visuals are a picture that you show someone that can, like, indicate something. For example, a visual is the McDonald’s M many people recognize all over the world. The McDonald’s M as McDonald’s and food and junk food and babies and toddlers as young as two can begin to recognize symbols. So why visuals are so important when kids are having communication difficulties like people with autism is a picture tells a thousand words. That picture of the m of McDonald’s tells you there’s food, there’s a restaurant. I might get my hamburger, but it tells you what it is and it means a whole bunch of things. So pictures are extremely important for people with autism.

It helps them communicate even if they can talk. So I hear a lot of parents that say, but my child can talk. I don’t need visuals. Well, visuals help decrease the stress. Remember, we talked about that people with autism have trouble in part one reading facial expressions and and following a lot of social communication with friends. Whereas a picture you, don’t have to use words and you show them a picture and they can get it.

So I have a story for you. I had a young man who was in his home and he could speak. He was able to talk in full sentences. But his mom had called this in because she was having a lot of trouble, that he was always raiding the fridge and drinking all the family’s iced tea. So he kept going into the fridge and she would tell him, no, no, no, you can’t you can’t go in, no, no more. And she would try to explain it to him, but he kept going into the fridge. So when we were there, we said, let’s try a visual. Let’s show him a picture. And we had a picture of an X and we took some tape and we put that picture of the X on the fridge.

So the next time that this young man went towards his fridge to try to get out his iced tea, we had the mother point to the X and say, “Nope, no iced tea, no fridge.” And guess what? He walked away so that X was worth a thousand words. So a thousand noes could have been said and that X communicated it to him. And the same thing happened when we use that X in other situations for him in cupboards that he wasn’t supposed to go into, in other things that he wasn’t supposed to touch. And it worked. It doesn’t always work. You have to stand strong. So if you’d put that X up and the child or young adult still tried to get in the fridge, you’d have to not let them get in. Otherwise they will not pay attention to your X in the future. You have to be consistent as a parent or as a caregiver. You can’t let them get in that fridge, that x, not that time, not in those few moments anyway. But when you want them to have access to the fridge, you can take the X off and then they can go in the fridge. So again, just to summarize, a picture can bring a thousand words into play and is much less stressful and decreases anxiety in people with autism. I’d love for people to just try using pictures, try it, see if it helps. It can decrease you talking and arguing and fighting with your child. So really what that X was was a prompt. It was a reminder for that young man, oops. Right. Not allowed in the fridge. Oops. Got it. It was a reminder in the world of therapy, it’s called a prompt to help him remember.

Bethany Hartropp

Okay. It sounds like it’s a very powerful thing, too, because it’s that one picture that carries a lot of weight to it and really helps him remember something that he is or is not allowed to do. Yeah.

Cynthia Miller-Lautman

Yeah. So the visual routine shows you the steps that someone needs to do. But a visual shows you one thing, tells you one thing, I’m not allowed to do this. Like an X or a no iPad picture.

Bethany Hartropp

Okay. Cynthia, in a previous podcast, we talked about how people with autism may be easily overwhelmed by the environment and space. Would you be able to talk more about the sensory difficulties that people with autism might have? Please.

Cynthia Miller-Lautman

Sure. I think it’s important we probably repeat it. We talked about it in part one, but it’s really important that everyone understand this when you’re trying to help people with autism or through sensory regulation difficulties. So we talked about our typical day when we wake up, we might feel on low in the morning, we’re tired, but we can wake ourselves up by having a coffee, maybe going on a walk, or splashing some water on our face, having a shower. And we can get to just right so we can get to work on time. If our child has a tantrum during lunchtime, when we have them home for lunch, we are on high our heart is beating. But we can take a few short breaths, do our drive back to work, drop our child back at school and we can calm ourselves down enough to get back to our work.

Cynthia Miller-Lautman

Afternoon a meeting. Be on time. The difference is you are able to get yourself to just right, even though if you feel on high or on low. But someone with autism has a lot of trouble going from low to just right or high to just right. In fact, so many people with autism talk about getting stuck in the extremes of low or high and not knowing how to get back to just right. So they often have behaviors that look like behaviors to all of us that they’re doing on purpose. But really, they’re just trying to regulate their bodies to get back to just right. People with autism often can get stressed with what is going on around them more easily than people without autism. This brings us to why we need the use of sensory safe spaces.

If people with autism can’t easily get to just right, we’ve got to try to help them get to just right and make sure they have the most opportunity to get to just right. So a sensory safe space is a space that helps the person with autism get back the right energy. So, for example, a child that won’t go into the class because they’re overwhelmed by the noises and the sounds in their classroom, what we could do to help them be able to go into that classroom would be to maybe give them before they walk in some noise canceling headphones that they would put on their ears, kind of to block out the noises of the class. We also might have a mini tent set up in the classroom where they could go into to block out all the visual distractions that they might feel when they first enter that classroom. Now, this doesn’t have to be fancy. It could be a sheet over their desk or a desk in a corner of the classroom that they can go with a cushion and hide under with their earphones on so they can get to just right before they have to go and head out into the world of that noisy classroom.

So there are some kids, though, that even with that, the noise canceling headphones in that little sensory safe space in the classroom, that it’s still too much. So some kids really need more time in other environments, they might have to go to the special needs room of the school to calm themselves down. So where it’s quieter and there’s less people and they might need to spend good chunks of their day outside of that noisy class to make sure they get to just right. So some of the communities, Mistissini is one that the special needs room has a teepee tent set up in their space. So it’s like a quiet tent in the special needs room that a child can go in to to get to just right. Some of these kids might have to wear noise, canceling headphones or listen to calming music or earplugs all day.

So there are so many more examples I can give you, but I wanted to start there. But with adults I thought I would share you a story. So if you remember Hayley who was really overwhelmed by the environment at her gathering. So she was really stressed out when she was in there and really needed to leave. She was trying to escape the noise and the people and all the touch experiences in that gathering. So one of the things you could have done with an adult like this who you knew would be stressed out by loud gatherings, was to make sure she was calm before she goes in, take some extra steps before she goes into the gathering. So that might be a walk before the gathering to calm her down in nature, even just around wherever you’re going outside.

She could be listening to calm music when she walked in so that she wasn’t hearing all those noises that were in the gathering. You could also have an iPad for them ready so that if they needed to take some space by themselves in a corner to calm down, that would be something you could do. The other thing I would really recommend is when you have someone with autism that is trying to integrate into community event, it’s really nice to have a buddy or a companion for them. So someone that would be responsible if they started to show signs of being not just right. So on high really upset or starting to get very sleepy and not responding and wanting to sit slumped in the corner. So if they’re on high, the companion or the buddy could start recognizing those signs. Oh, they’re starting to make a lot of noises and starting to plug their ears, flap their hands, as we talked about in part one.

And then that buddy could encourage maybe to take them to the side of the room, give them some music on their iPad to listen to or their iPod. And if they’re really still showing signs of not being on just right and getting really too high and overwhelmed by the environment, you could get that buddy to make sure they take them outside before the tantrum, before the running away begins. So it’s really recognizing those early signs of overwhelm and making sure that they get to a space that can bring them to just right and hopefully that they could then return to your gathering and the whole family wouldn’t have to leave.

Bethany Hartropp

So, Cynthia, it really sounds like what you’re talking about is helping the person find their just right, using different strategies and like little by little exposing the person to the environment and finding ways for them to be able to go to all the different events that they want to go to, that their family goes to the community gatherings and finding ways so that they can be part of this. And like with Hayley, you were saying you were like go for a few minutes at a time maybe, go and then take a break and then go back and take a break so that she can still be part of it.

Cynthia Miller-Lautman

Yes. I mean, there’s many families that talk that it’s really hard for them to attend gatherings or noisy big events with their children with autism, and then they are left out of family gatherings. And so a little bit of time and a little bit of time outside can really make the difference of the child or young adult or adult with autism to be able to participate. You’ve got it right. I do have another story. There’s a lot of families and parents that talk about how do I make a sensory safe space at home? I myself at my cabin, it’s a very small space. I have three children and one of my daughters really, really has trouble getting to just right, especially at bedtime. She shares a room with her two siblings.

They have bunk beds and a pull-out bed underneath and she has trouble. She is always bothered by the noises that her siblings make and she can’t get from high to just right, to low, to fall asleep. So one of the things we’ve done in a small space is we’ve put up a sheet. She’s on the middle bunk. So my one of my daughters is on the bottom bottom that rolls out and she’s on that middle one. And we put a sheet. So she has her privacy. We hang it from the top bunk and she has her own little tent in her space. So that blocks out the visual and the lights of her and the bothersome things of her sister and brother. But we also give her an iPod or access to listen to calming music because that blocks out all the sounds that bother her so much.

So we are able to make a sensory safe space, you know, really small. So her bed is her sensory safe space and she can block everything and most of the time she can go from high, to just right, to low to, fall asleep. Another sensory safe space that can be used is the land. People with autism may respond well to land based activities. Some families have told us their experiences and their success with bringing their family member with autism onto the land and how much they enjoy the land based activities. Many of them are spending a few weeks, a year or every few months in the bush. I have one particular story of a grandfather that shared his story with me about taking his autistic grandsons into the bush, and he felt they were so much calmer and happy while they were in the bush. He remembers that they were able to walk around free and they weren’t trapped indoors and they were often calmer in nature. It’s like they had a sense of purpose following the routine of being at camp, you know, getting the fire, going outside, helping collect the water. So it really was mimicking what this grandfather’s story was, that outside was a sensory safe space and they were following a routine.

Bethany Hartropp

And there are many benefits to being on the land. Parents who have mentioned to me that being on the land means that they’re not juggling work. And those pressures of community and home life as well, that they are completing one schedule and they’re just doing that routine. That is the routine of camp. And there are fewer demands and it’s much easier for the whole family as well. And like you said, it’s a sensory safe space. Yeah.

Cynthia Miller-Lautman

So in summary, on this podcast, we’ve talked about three main things that you can do right now to help your loved one with autism, and that is visual schedule routines, visuals and sensory safe spaces. You can put these in place without a diagnosis. And right now, without the help of professionals, we really encourage you to try these three things with your children and young adults with autism. Bethany, I wanted to thank you so much for spending the time with me on these podcasts on autism.

Bethany Hartropp

Cynthia Thank you for having me. Meegwetch

Cynthia Miller-Lautman

We hope you enjoyed our two episodes on autism. If you are interested in more details on autism, we do have a full day training on behavior, on autism, on video. You can request to have access to these videos from your case manager who will contact our disability programs department. We do want you to know that a disability is only one part of a person and that there are a lot of gifts that the person brings to their family and community. It will be really important for you to help find those gifts and to encourage them in your children and adults with autism. We are sending a special mention out to all the people who are living with or helping someone with a disability. Thank you. We know and appreciate all the hard work you do.

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