In an article by Plum and Weatherby (2013) they compared the vocalizations of three different groups, described as the "typically developing" (TD), "developmentally delayed" (DD) and "autistic spectrum disorder" (ASD) group. This study had three objectives, however, I focused on the following objective: Compare communicative and non-communicative vocalizations displayed between children 18 and 24 months of age. They define vocalizations as phonetic complexity and syllable structure.
Findings revealed that when children with autism vocalized it was with less communicative intent. Furthermore, when vocalizing communicatively, they were less likely to do so for joint attention when compared to the DD and TD groups. According to Plum & Weatherby this is consistent with the fact that children with ASD have difficulty communicating for joint attention. All three groups also used non-transcribable vocalizations, which were defined as a non-syllabic vocalization with a vowel and atypical phonation. However, when compared to the DD group, the ASD group used it more during acts of behavior regulation. Overall, the ASD group produced more vocalizations for acts in behavior regulation than for acts in joint attention. Plum & Weatherby also found one vocalization that set the ASD group apart from the rest. The ASD group produced more "distress" vocalizations (e.g. cries, whines, screams) and this is consistent with the difficulties in regulating emotions that most children ASD experience.
Based on their findings, there are implications for early identification and early intervention services between the ages of 18 and 24 months. Plum & Weatherby suggest keeping a close eye on distress vocalizations during screenings and evaluations. They state that increased frequency of distress vocalizations can be a severe red flag of autism. Also, according to Plum & Weatherby, emotional dysregulation should be a session target because it decreases optimal arousal levels which are necessary for learning and development. They encourage SLPs to target communication to express the functions of behavior regulation, joint attention, and social interaction. Plum & Weatherby indicate this may decrease distress vocalizations associated with communicating basic need and wants and simultaneously increase reciprocal social interactions.
Reference: Plum AM and Weatherby AM. "Vocalizations in toddlers with autism spectrum disorder." Language, Speech, and Hearing Research. 56(2013): 721-734. Retrieved from jlshr.pubs.asha.org
In reading the article, "Interdisciplinary Assessment of Young Children with Autism Spectrum Disorder," the section on cultural competence drew my attention. Prelon, Beatson, Bitner, Broder & Ducker (2003) describe cultural competence as a continuum.
Prelong et al. describe the bottom of the continuum as destructiveness. In this phase, the SLP views the family's culture as a "pathology" in which access to appropriate services is potentially blocked. Next on the continuum is described as cultural incapacity. This is described as the phase in which the SLP demonstrates low expectations for the language minority child. In addition, the SLP displays few cross-cultural skills. Cultural blindness is when SLP's do not think about cultural differences or see them as stereotypical. Furthermore, as part of pre-competence the SLP begins to recognize their own cultural beliefs and biases. The SLP reaches cultural competence when they are able to acknowledge and accept the cultural differences. The final step of the continuum is cultural proficiency, which the SLP has reached once they begin to serve as mentors, teachers and collaborate or contribute to the field.
In our field, it is important to consider cultural factors because overall communication, including social norms, can vary significantly from one culture to another. As clinicians we should be metacognitive about our own cultural bias so that we can provide culturally appropriate services or at least get on the right path.
The following is recommended for a strong bilingual EI program:
- Demonstrate a positive attitude towards the native language and create a sense of collaboration with English to support bilingual language development.
- Teach language concepts (e.g., naming, requesting, commenting) instead of teaching English (or home language) vocabulary skills only.
- Use culturally appropriate materials and incorporate the native language and cultural rituals into the therapeutic activities (e.g., songs, books, facilitated play activities, etc.).
- Present written material in both languages to ensure greatest understanding.
- Investigate and share information on the development of the native language and
- bilingualism overall, instead of translating information regarding English language development.
CSHA Diversity Committee 2003-2004. Early Intervention For Culturally and Linguistically Diverse (CLD) Populations. http://old.csha.org/documents/diversity/EARLYINTERVENTION.pdf
Prelock AP et al. "Interdisciplinary Assessment of Young Children with Autism Spectrum Disorder". Language, Speech, and Hearing Services in Schools. 34(2003):194-202. LHSS.pubs.asha.org
In the article, Issues in Bilingualism and Heritage Language Maintenance: Perspectives of Minority-Language Mothers of Children With Autism Spectrum Disorders, Betty Yu discusses bilingualism in children with autism. She indicates that families of children with ASD are often reluctant to speak to their children in their native language for fear of confusing the child or "exacerbating" the impairment. As SLPs in a culturally and linguistically diverse country, we are key to helping families understand the role of their native language in the child's impaired language development. Yu emphasizes the message often given to families by professionals in the field that they should speak English only.
Yu states that encouraging parents to speak English only contradicts ASHA's position statement (2004, 2005, 2011), which urges practitioners to regard the families' cultural and linguistic preferences. Yu indicates that native languages are key to the following:
- facilitation of cultural identification
- transmitting family values
- fostering intimacy
- promoting attachment
She moves on to say that asking parents to speak English only is unsupported by research. Yu cites Genesee, Paradis, and Crago (2004), who argue the inappropriateness of advising that children with language impairment should learn only one language. She continues to cite Paradis and Crago, indicating that the circumstances of each child should be individually assessed to determine whether dual language use is suitable.
Yu indicates that only a few studies to date have been conducted with children that have autism as far as bilingualism is concerned. One study Yu cites was conducted by Hambly and Fombone (2012) which compared three groups of children. One was a monolingual group, the next was bilingually exposed for 12 months prior to the study, and the last was bilingually exposed 12 months after the study. Hambly and Fombone assessed the following: social responsiveness, initiating of pointing, response to pointing, attention to voice, total conceptual vocabulary, words in dominant and second languages, age of first words, and age of first phrases. Their study concluded that children with ASD that were bilingually exposed did not demonstrate additional delays compared to their monolingual counterparts. No significant difference was found in those particular skills between bilingual children that were raised bilingually vs. sequential bilingual environments. Hambly and Fombone (2002) reported that 60% of the bilingually exposed children were observed to be acquiring vocabulary in two languages. Yu cites other studies as well in this article.
As Paradis and Crago stated, the circumstances for each individual child should be assessed. Some questions or factors to consider might be the following:
- Are the parents fluent English speakers, bilingual as well? - If the parents are fluent in English they may choose this language over the native one until the child demonstrates the ability to communicate proficiently in English.
- Is English language proficiency limited? - If English proficiency is limited in the family then this may limit language rich vocabulary.
- Is the family more "Americanized" or acculturated? If so, to what extent? - Some families might highly value American culture and want their child to speak English first.
- Does the child attend preschool? - Some parents might fear that if they speak their native language their child might have a hard time communicating in English with other children in the community or a school setting.
I would never ask a family to speak English only if their English language proficiency was very poor because this compromises their ability to give their child a rich vocabulary. I always advise parents to speak to their children in their language rich vocabulary and I explain why, whether they have ASD or not. Often, parents of bilingual children fear that two languages might confuse their child or worsen the delay. However, this is not the case. Although, if you are working with a bilingual family that is also English proficient, you can explain the benefits of bilingualism but they ultimately decide which language they feel is best for their child. It is important to explain the benefits of bilingualism and be able to answer or clear up any doubt the family might have to help them make an informed decision regarding language use.
Yu B. "Issues in bilingualism and heritage language maintenance: perspectives of minority-language mothers of children with autism spectrum disorders." American Journal of Speech Language Pathology. 22.10-24(2013). ajslp.pubs.asha.org.
Sensory Processing Disorders (SPD) and autism (ASD) are two conditions that can exist one without the other or they can be comorbid. Making a clear distinction between the two is important especially since SPD can look like autism. SPD is diagnosed by an occupational therapist that is trained in sensory integration. A child with SPD can easily be misdiagnosed for a child with ASD due to sensory processing problems/symptoms children with autism experience. As I have defined in previous blogs, ASD is a neurological disorder that affects normal brain function and significantly impacts development of the person's communication and social interaction skills. SPD was formerly known as "sensory integration dysfunction." Our neurological system helps process signals received from our senses by turning them into appropriate motor and behavioral responses. Therefore, SPD affects how a person receives, integrates and makes sense of sensory information.
According to the Sensory Processing Disorders Organization, 1 in 20 children suffer from SPD. In addition, high rates of SPD are often found in children with autism. However, according to the SPD Foundation most children with SPD do not have autism. They are described as two separate conditions. Consequent to similarities, children with SPD run the risk of misdiagnosis.
The following are signs of SPD in infants:
- Problems eating
- Trouble falling asleep or staying asleep
- Extremely irritable when I dress him/her; seems to be uncomfortable in clothes.
- Rarely plays with toys, especially those requiring dexterity
- Difficulty shifting focus from one object/activity to another
- Does not notice pain or is slow to respond when hurt
- Resists cuddling, arches back away from the person holding him
- Cannot calm self by sucking on a pacifier, looking at toys, or listening to my voice
- Has a "floppy" body, bumps into things and has poor balance
- Does little or no babbling, vocalizing
- Is easily startled
- Extremely active and is constantly moving body/limbs or runs endlessly
- Seems to be delayed in crawling, standing, walking or running
The symptoms will vary depending on the age group. The above-mentioned symptoms are distinct to SPD, not autism. However, these two conditions do coexist. So if you come across a child on your caseload with sensory processing difficulties, before you think autism consider the child’s social and communication skills. In addition, consider if the child exhibits any repetitive behaviors. The child may very well have SPD and not a suspected autism.
Reference: Sensory Processing Foundation. Retrieved from www.spdfoundation.net.
I recently came across an article by researchers, Dr. Jones and Dr. Klin from Autism Speaks Baby Siblings Research Consortium (BSRC). They studied a total of 110 infants, 59 of which were considered "high risk" consequent to having a sibling on the spectrum. The remaining subjects did not have a family history of ASD. Eye tracking technology was utilized to measure social cue responses as presented through a video of a "friendly caregiver."
Each infant was tested a total of 10 times between the ages of 2 and 24 months. According to the researchers, baseline levels demonstrated similarities in eye contact between the two groups of infants. They found that infants who did not develop autism increased eye contact over time, as expected in development. On the other hand, eye contact declined for the 13 infants that were later diagnosed with autism. Twelve out of the thirteen later diagnosed were from the "high risk" group. Furthermore, they reported eye contact rapidly declined by age 3.
The decline in eye contact was detectable through eye tracking technology only and not the naked eye. According to Dr. Wang, Autism Speaks vice president for Medical Research, "The new eye-gaze findings suggest that subtle symptoms can be present at a very young age and that these very early symptoms may continue to worsen over time." However, he adds that the study was too small to conclude if this technology would be used in the future to diagnose autism.
I thought the findings were very informative but was disappointed to learn that the decline in eye contact was not visible to the naked eye. Visible declines in eye contact can be an important indicator, if noticed. Even though the declines are not reportedly visible to the naked eye it is important that caregivers be alert for potential noticeable declines. A child with a potential risk for a diagnosis of ASD will eventually reach a point in which eye contact will noticeably diminish. In addition to declines in eye contact, other red flags should be considered in conjunction.
With the increasing rates of autism in the United States, families should educate themselves on early warning signs especially when there is a family history or if the child is not reaching expected milestones. Pediatricians also play an important role as they track child development through well-child care visits. However, parents know their children best and with the right information can help detect a problem early on which can potentially lead to a more desirable outcome later.
Reference: Study: Eye Contact Declines Early in Babies Who Later Develop Autism. (November 2013). Science News. Retrieved from www.AutismSpeaks.org.
In one of my initial blogs, I discussed how it is not within the scope of the speech pathologist to diagnose autism. However, I would like to emphasize that this is not the case when working as part of a diagnostic team. According to ASHA's position statement (2006), under diagnosis:
"Speech-language pathologists who acquire and maintain the necessary knowledge and skills can diagnose ASD, typically as part of a diagnostic team or in other multidisciplinary collaborations, and the process of diagnosis should include appropriate referrals to rule out other conditions and facilitate access to comprehensive services." (www.asha.org)
I would also like to clarify that if you are a therapist rendering services and suspect autism consequent to the symptoms as defined by the new diagnostic criteria in the DSM V, you cannot diagnose the child. It must be done as part of a diagnostic team. By the time the SLP begins providing services in the home, the child has already been evaluated. However, at that point you can make a referral for a psychological evaluation but not diagnose.
According to ASHA, SLP's are often the first to notice communication deficits and social limitations. This is true because during the evaluation process we are often one of the first providers to enter the home. Therefore, it is urgent to communicate your findings with other professionals that evaluate the child regarding any potential red flags. Appropriate referrals and diagnoses can be made even before initiation of services if the red flags are detected and communicated. Early intervention services are always beneficial especially for a child with a potential diagnosis of ASD.
I would also like to add that Autism Speaks has a video glossary in which both parents and professionals can learn about the early symptoms of ASD. There are over 100 video clips available for your viewing. It is free of charge and viewers must register to access. This glossary could be helpful for professionals across domains. Furthermore, the videos can help confirm if observed behaviors are in fact red flags.
Please feel free to share your experiences as they relate to this topic. I would love to hear about them!
Autism Speaks offers a manual for families of children that have been diagnosed with autism which is described, as "critical information families need the first 100 days after an autism diagnosis." The manual is 66 pages and is available in Spanish as well. The Spanish version is a bit lengthier at 84 pages. "The 100 Day Kit" is divided into the following five sections: About Autism; You, Your Family & Autism; Getting Your Child Services; Treating Autism; and Making It Happen. In addition, the manual contains useful forms, a glossary and information on local resources.
The "All About Autism" chapter defines autism and discusses how it is diagnosed. In addition, it provides statistical information and medical issues that may coincide with the diagnosis, etc. "The You, Your Family & Autism" chapter discusses the impact on the family and provides readers with useful tips. "Getting Your Child Services" helps guide families with accessing services and discusses special education and the child's rights. The last chapter, "Treating Autism" describes a variety of interventions.
The manual can be accessed through the Autism Speaks website under the "Family Services" tab under "Tool Kit." There is a short request form to complete. The manual is free for families that have a child that has been diagnosed within six months of the date the manual is requested. Otherwise, it can be purchased. It is also free for professionals that work with the population. It is a great resource for anyone working in the field especially if you are a new provider that would like to help guide your families. You can also refer your families to the comprehensive manual. If the family does not have access to a computer, perhaps you can print out some of the most important pages and share it with them.
In my opinion, this is a great way to empower your families, especially those with limited access to information. It provides them with key information and can serve as a guide. Furthermore, it can help minimize some of the anxiety and stress that can accompany a new diagnosis. Check out the manual and feel free to share your opinions!!
Targeting pragmatic goals can be a challenge within the context of the Early Intervention setting. There are a few challenges that can arise when trying to target these goals. Consider the following, as you may find some of these in common as well: scheduling conflicts, limited opportunities for contact with other children during community outings, and parent reluctance to go into the community.
Scheduling conflicts due to child or clinician availability can make it difficult to schedule a session in the community. If your session is scheduled for an evening time families may be more reluctant to go into the community, especially after they come home from work. If this is a factor then perhaps you can ask the family how they would feel about a play date with one of the child's little friends. A play date in the family home can be a great idea because you can structure the session and control the environment to a certain extent. This is probably one of the best ways to create social opportunities for that child and most optimal to train the parents during your EI sessions.
Even if you are able to go into the community it may be difficult to structure your session with other children for a number of reasons. Controlling the environment outside of the home is difficult because of the unpredictability. However, some places that might work for your session are a park or library. If you have your session in a park you want to ensure you are there during a time of the day in which you will find age matched peers in order to promote social communication and create social opportunities for that child. Most libraries have reading/literacy groups for children of different ages in which you can also create social opportunities. Taking community outings to stores (supermarket, local drugstore, local grocery store, etc.) and having the child pay in order to use social greetings could be a way of targeting some pragmatic goals. Community outings are also a great way of modeling social language for the child.
Parent reluctance can probably pose the greatest challenge. If the family is unwilling to go into the community then it is out of your control. I would not press the family to do something they are not comfortable with. The family may even have reasons they may be unwilling to share. However, if you have established good rapport with the family then they may be willing to share it with you. If you sense reluctance then you can gradually present the idea and feel them out. Perhaps you can start with a play date and if that is successful they may change their minds about going into the community.
How have you approached the topic of community outings with your families?
Transference and countertransference are naturally occurring phenomena in relationships. Under a therapeutic lens, transference has to do with specific feelings a client can have towards a therapist, countertransference has to do with feelings a therapist can have towards a client. These may occur without our own awareness, and can in fact impact your actions and responses towards your client in therapy. This phenomenon can affect how you feel towards a client and vice versa.
Transference and countertransference can work for or against you in therapy.
Consider the following example of transference: You remind your client of someone in their family. If they dislike this person, it may have a negative impact on your relationship and reflect in your therapy. However, if the child's feelings towards that person are positive, that may help nurture a good relationship between you and your little client.
Considering countertransference, if a client or even their family reminds you of someone, your treatment towards the current client/family may be affected by your past feelings or relationship. For example, you may treat some families preferentially without realizing it, if the similar past client/family relationship or feelings were positive.
It is important to understand and have a certain level of metacognition with both transference and countertransference as they can impact therapy. If not identified and managed accordingly, the therapeutic relationship can flourish or become stagnant early on. However, no matter the feelings, maintaining a certain level professionalism is important. Understanding how to manage those feelings should be considered in order to create a positive therapeutic environment. Children can easily pick up on the feelings of those around them (e.g. anxiety, contentment, anger, etc.). Your little clients deserve the best of you and a good place to start is by opening your mind to how your behaviors and feelings impact your clients in therapy.
Have you have experienced transference and/or countertransference? How did you manage it? I would love to hear from you!
To maximize therapeutic outcomes it is important to consider the child's schedule, including other therapies such as ABA, PT and OT as well as family routines such as the child's napping schedule. PT and OT sessions tend to be 30 minutes long in comparison to ABA sessions, which can last up to 2 hours or more. ABA is defined below for those readers that are not familiar with the approach.
ABA stands for Applied Behavioral Analysis. ABA is a highly structured, rigorous, systematic and consistent teaching approach based on the work of Dr. B.F Skinner. Reinforcers are used in order to help shape behaviors. ABA treatment is frequently used to build the following skills:
- Toilet training
- Maladaptive living skills (e.g. feeding, dressing, bathing, etc.)
- Expressive language (e.g. labeling objects, people, and emotions, etc.)
- Receptive language (e.g. following directions, etc.)
- Play skills (e.g. how to play with toys)
- Social skills
In my opinion, for most cases, speech therapy sessions should be scheduled before ABA therapy. ABA sessions can be very intensive due to the behavioral nature of the therapy, including the length. If your session is scheduled following an ABA session, the child may be more tired or fatigued for your session consequent to the length of the ABA session. Another factor is that since ABA sessions are highly structured and rigorous, the child may be unwilling to sit or follow directions for yours. Scheduling can be important especially for children with a more severe case of ASD and including those with a new diagnosis. A pre-diagnosed child will go from receiving Special Instruction (SI) to ABA and this may be a difficult transition because of its rigor and length.
Scheduling your session around the PT's schedule can have some pros and cons. For example, if the child has been very active in their PT session consequent to gross motor activities, they may be more willing to sit for yours. On the other hand the child may be fatigued from the gross motor activity and less willing to participate. In this case, it would depend on the child's disposition and it is something you would have to play by ear.
In my experience, the OT sessions have never really impacted the child's behavior for my speech sessions. OT sessions are similar to speech in which they can vary in activity types ranging from seated activities to gross motor ones.
As part of the family routines, naps are also critical because if your child has just awakened from a nap or perhaps not napped, this can cause behavioral difficulties in your session.
The factors mentioned above depend on the child as a whole and the family. Due to scheduling conflicts you may have to schedule your session at a particular time that you may feel is not the most optimal for the child. Scheduling is not always in our control, especially if you are new to a case that already has a set schedule. I recommend always maintaining an open dialogue with the family and therapists so that as a team you can work together to create a schedule best suited for the child.
Below is a list of three well-known organizations for families with children that have autism or can be used as general resources for professionals, students or the general public. These organizations can provide families with a wealth of information and resources. The following organizations can help give families a better understanding of the diagnosis and can provide information about a variety of support groups, workshops, and different ways of getting involved with the organization. They also provide research information. Online support groups can also be an alternative for families that simply cannot make it to a meeting or perhaps would prefer to participate through an online medium. When recommending organizations to families, it is important that you research them and ensure they are reputable. Furthermore, as I mentioned in a previous blog, if you work with a few families that have a child with autism you can try to connect them if they are open to the idea.
1. Autism Society
Contact: (800) 328-847
Autism Society was founded in 1965 by Dr. Bernard Rimland, Dr. Ruth Sullivan and other parents of children with autism. The Autism Society is a leading and reliable source of information about autism. They have affiliates in 39 states
2. Autism Speaks
Contact: (888) 288-4762
Spanish (888) 772-9050
Bob and Suzanne Wright, grandparents of a child with autism, founded Autism Speaks in February 2005. A friend of theirs donated $25 million to help launch the organization. Autism Speaks is one of the world's leading organizations in autism science and advocacy. The organization is dedicated to funding research into the causes, prevention, and treatments. They also strive to increase awareness of autism spectrum disorders and advocate for the needs of individuals with autism and their families.
3. National Autism Association
Contact: (877) 622-2884
NAA has local chapters in nine states including: Arkansas, California, Indiana, Kansas, Massachusetts, New York, Ohio, Texas, and Utah.
Providing families of children with autism information can be very helpful. The information can especially benefit those families that are encountering autism for the very first time or families with limited access to information. However, the delivery and amount of information provided can also be a sensitive issue. The information that you provide families should be a helpful resource and not the source of any stress. Here are some suggestions:
- Ask the families if it's okay to provide them with information
- Inquire what kind of information the family might be seeking
- Make recommendations on types of information if the family is not sure where to start
- Direct the parents to online resources if they are willing to do some of their own research
- Print out material for families if they do not have access to a computer
After a diagnosis, families may undergo enormous amounts of stress for a variety of reasons. As a result, it is advisable to give families small amounts of information at a time instead of bombarding them with too much information at once. Focus on providing families with information that is a priority to them. If the families are unsure what information they should be researching, perhaps you can orient them by suggesting they make a list of general questions or concerns including more specific concerns related to language and communication.
Discussing family needs as far as resources and information with other providers can minimize the chances of redundancy. You also want to ensure the usefulness of the information provided especially with the family of a newly diagnosed child. Discuss the family's response to the information provided in order to determine if the information is helpful or a source of stress. Providing families with information as means of support can reduce stress levels, if delivered appropriately. This can also help families understand, direct therapy, and help the clinician develop functional outcomes based on their priorities. Overall, information can empower families to make informed decisions.
How do you help your families find the information they need?
According to Autism Speaks.org, the DSM-V has been revised with new diagnostic criteria for autism. Autism is no longer classified into the following subtypes: Pervasive Developmental Disorder, Asperger Syndrome, Child Disintegrative Disorder and Autistic Disorder. Autism symptoms are now classified under "Autism Spectrum Disorder." Instead of three domains (social impairment, language/communication impairment and repetitive/restricted behaviors), two categories are now used for diagnosis: social communication impairment and restricted interests/repetitive behaviors.
In addition, the DSM-V has added the Social Communication Disorder (SCD). Children diagnosed with SCD have exclusive difficulty with the use of social language. However, please note that this is considered a communication disorder and not considered an Autistic Spectrum Disorder even though it appears to be pragmatically based. The following is the diagnostic criteria for the SCD disorder as listed in the DSM-V.
A. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:
- Social communication deficits (e.g. greeting, information sharing appropriate to social context)
- Impairment of the ability to change communication to match context or the needs of the listener
- Deficits in following conversational rules and storytelling (e.g. taking turns in conversation, rephrasing, use of verbal/nonverbal signals to regulate interaction)
- Difficulties understanding what is not explicitly stated (e.g. making inferences) and nonliteral meanings of language (e.g. idioms, humor, metaphors, multiple meanings that depend on the context for interpretation)
B. Deficits result in functional limitations in effective communication, social participation, social relationships, academics, or occupational performance
C. Early onset
D. Symptoms are not attributable to other medical or neurological conditions
Remember to consider social norm variation across cultures to avoid confusion between symptoms and cultural differences. For example, story telling and conversational rules vary significantly from culture to culture. In addition, school age children with language disorders or learning disabilities often have difficulty with nonliteral meaning as described under #4, including idioms, humor, metaphors, etc. This is also culturally dependent.
Considering these changes, what do you think about this new Social Communication Disorder?
Support groups can be a wonderful way for families of children with autism, especially for those that have a child with a new diagnosis, to connect with one another. In my own practice, I have worked with families ranging from those that had a solid knowledge base on autism and were proactive to families that had a newly diagnosed child that were so overwhelmed they were not sure where to start or how to access information. This can be a difficult time for families and as SLPs we often want to help by giving them as much information as we can. However, unless we have walked in the shoes of a parent that has a child with autism we cannot say we know how they feel.
Have you ever tried to connect one parent with another as a form of support? This could be a great way to help the parents you work with acquire more information about autism. This can be especially helpful for families that have a child with a new diagnosis. A new diagnosis can trigger stressful events in a family such as coping with the idea that their child may not have the life they once thought they would. In the past, I have tried connecting parents with one another, but it can be tricky. These are a few questions to consider if you try to connect families:
- How long have you been working with the family?
- Do you have a good relationship with the family?
- Do you think the family is open to discussing the diagnosis?
- How long has it been since the diagnosis?
- Do you think the families can offer support to one another? How?
- Does one of the families have a good knowledge base on autism?
If you decide that perhaps connecting one parent with another might not work out, you can consider providing the family with information about support groups that may offer free sessions. Most families may not even know that support groups are available to them and at no cost. Helping families understand and learn as much as they can about autism can also lead to more desirable therapeutic outcomes. This will make it easier for families to understand therapy objectives as well.
What have been your experiences with support groups? Feel free to post your comments sharing your experiences!
Often, the children on our early intervention caseloads tend to be over fifteen months of age unless there is some other form of severe disorder involved. We hear so much about the "red flags" often seen in toddlers, but rarely do we hear about red flags for infants. I think one reason may have to do with the fact that since children do no start producing spoken language until one year of age, the "early signs" might be too subtle to notice. This could be especially true for families from a low socioeconomic status with limited resources and access to information. Therefore, these children are not referred to early intervention until after they are expected to produce spoken language or - as I have seen in some cases - when they are expected to combine words. However, clinicians that work with infants should be aware of the early signs of autism since they can help detect a potential problem early. The following is a list of "red flags" for autism in infants:
- Smiles late or very minimally - occurs in the first few months of life
- Seldom makes eye contact with people - typically emerges between two to four months
- Does not respond to calling of their name with head turns - occurs between eight to ten months
- Does not turn or look when you point or say "look at this," - occurs between ten to 12 months
- Does not point at objects or people - emerges between 12 to 14 months
- Does not babble back and forth - established at six months of age. Babbling becomes more complex with more syllables between 8 to 10 months
- Demonstrates unusual movements, such as hand flapping, spinning, tapping or playing with the same toy in a way that seems odd or repetitive
- Doesn't explore surroundings with curiosity or interest
Even if a child is under-stimulated, the above-mentioned characteristics are developmental and should be evident. Although the under-stimulated child may not be overt in regards to these characteristics they should be acquired by certain ages. Don't forget to consider the above-mentioned characteristics when working with children under 15 months of age.