Engage My Brain

What we need is the awareness and patience to embrace people with autism as different, not less; the willingness to presume that people with autism are competent – even if evidence may be not be available at first; and the understanding that behavior is not random, but is instead motivated by necessity, frustration, sensory differences, or the need to communicate a request or thought.

People with autism may experience the world in ways that are unfamiliar to us, but they need us to remember that what we see on the outside may not be an accurate reflection of what exists within.

A key goal of intervention is to restore circles of positive, reinforcing, back and forth interaction that are so central to development. Because learning, language, and friendship are all dependent on repeated social interaction, structured, positive engagement is critical for a person with autism.

It’s important to consider all of these needs. Think of the following components as interlocking parts of an effective, comprehensive approach that – together – can make a positive difference for people with autism.
 

• Presume Competence

• Follow the Lead

• Make Communication the Centerpiece

• Offer Positive Behavior Support

• Include and Adapt

• Accommodate Sensory and Movement Differences

• Build Relationships

• Support Autonomy

1: Presume Competence

Researchers define praxis as the ability to execute skilled, goal directed movement plans and sequences; that is, translating the intention to act or speak into actual behavior.  Movement difficulties are among the earliest observable signs of autism.

Somehow we’ve come to accept that if a person cannot answer a question with his body, he must not know the answer in his mind. This is a dangerous assumption, because it can cut off opportunities and access for people with autism, limiting what they can learn based on what they can demonstrate rather than what they may actually be capable of understanding, learning, and enjoying.

What we believe about people with autism often has more to do with our measurement tools, which are designed for perfectly operating sensory systems, than with the people themselves.

2: Follow the Lead

More than a century ago, the American educator John Dewey set out a general principle that a growing body of research has repeatedly found to be particularly important in teaching and supporting individuals with autism: the doorway to learning is to follow the lead – by building directly on what is meaningful and desirable to them, and is therefore automatically interesting to them.

Following the person's lead and focusing on what is desirable or important to that person is the first step in restoring positive backandforth exchanges that are essential to learning, development and personal relationships.

Begin by being attentive to what interests the person with autism and what is relevant to her. This can be discovered by presenting choices of activities. Build outward from those interests to a broader range of activities, words and topics. As you expand the range, remember that if what you are doing stops being interesting, motivating or enjoyable to the person with autism, they may stop learning and start misbehaving.

A rich body of research demonstrates that strategies that allow choice and follow the lead of the person with autism are highly effective in producing improvements in communication, reductions in disruptive behavior, and generalization across settings. Very often, individuals with autism experience impoverished conditions and control by others that we ourselves would probably find intolerable. Not surprisingly, problem behaviors decrease as the opportunities to choose preferred activities, recreational activities and reinforcers are increased.

3: Make Communication the Centerpiece

The most motivating way to teach communication is, again, to tap into whatever is most interesting or urgent to that person. Remember this: Where there is interest there is mental attention.

Words need to be developed in the context of meaningful and functional interactions.

Speech is stimulated first by asking a question which requires thought by the person it is directed toward, prior to their answer. Once the individual is able to think and answer the question with simple spoken language, speaking confidence improves.

Parents and teachers provide a scaffold each time they expand an already familiar concept by asking leading questions (What else do you see?), modelingor elaborating new details. As the individual becomes more independently vocal, the support is gradually faded and skills are broadened.

The central technique is this: provide new information; reinforce the new word or concept through communication modalities that ideally combine language and movement (verbal and typing) simultaneously; engage reasoning by asking a question to provoke thought and discriminate the new information; and then branch (scaffold) from each successive point to introduce a chain of additional concepts.

In general, the teaching situation should be structured to avoid highly repetitive and narrow prompting, in preference for more stimulating topics and questions that assure against boredom and loss of interest, which would result in problem behaviors.

4: Offer Positive Behavior Support

Without a way to express needs, desires, feelings or opinions, the only way to communicate is through behavior.

Behavior is not random. It is motivated by necessity, desire or the need to communicate.

The central point is that behavior has a purposeful function. The problem with controlling behavior is that it often ignores the function that the behavior serves.

Think of behavior in autism like a long balloon. If you try to squeeze the air on one side of the balloon, it simply pops out somewhere else. Unless the underlying need is addressed, attempts to suppress inappropriate or undesirable behaviors in autism often result in the emergence of some replacement behavior that may be even less desirable.

A person with autism may flap his hands, verbalize phrases or noises, bite his wrist, and so forth – not out of willful disobedience or a desire to look different, but because these behaviors help him deal with anxiety, excitement, or a sensory system that is excessively or insufficiently activated. It is well established that low levels of external and internal (mental) stimulation are typical antecedents for sensory seeking or automatically reinforced behavior.
 

If Meaghan is repeating or pulling her hair, that is a sign that she finds your stuff more boring than her stuff. So, you can use that as a barometer.

Our goal is give the people with autism a way to achieve their needs more effectively than with the existing behavior.

The goal of intervention is education, not simply behavior reduction. The broader is to produce change that positively affects how people live their lives.

6: Accommodate Sensory and Movement Differences

To learn the technique of moving my right hand needed control over the ball and socket joint of the shoulder and then the hinge joint of my elbow and finally fold the other fingers and keep the point finger out. After that, focusing on the object which matched the word. --- Tito Mukhopadhyay

Sensory and movement differences are important because they affect how people with autism experience the world internally, they interfere with their ability to share thoughts and demonstrate competence, and also because many behaviors in autism emerge as strategies to regulate these sensory and movement differences.

When I was growing up, speaking was so frustrating. I could see the words in my brain, but then I realized that making my mouth move [was needed to] get those letters to come alive, they died as soon as they were born. What made me feel angry was to know that I knew exactly what I was to say and my brain was retreating in defeat. --- Jamie Burke

There are times when I can’t do what I want to, or what I have to. It doesn’t mean I don’t want to do it. I just can’t get it all together somehow. Even performing one straightforward task, I can’t get started as smoothly as you can. Here’s how I have to go about things:

    1) I think about what I’m going to do.
    2) I visualize how I’m going to do it.
    3. I encourage myself to get going... – Naoki Higashida, When I Jump

There are times when I can’t act, even though I really, badly want to. This is when my body is beyond my control. It's as if my whole body, except for my soul, feels as if it belongs to somebody else and I have zero control over it. I don't think you could ever imagine what an agonizing sensation this is.

You can't always tell just by looking at people with autism, but we never really feel that our bodies are our own. They're always acting up and going outside our control. Stuck inside them, we're struggling so hard to make them do what we tell them. – Naoki Higashida, When I Jump

"I agree with him. I get so fed up with my body that I really want to scream." --- Meaghan B.

Providing additional visual and proprioceptive feedback is an essential strategy that can help to bridge the gap between intention and action.

    1) Haptic feedback

    2) Modeling

    3) Passive touch: Touch given prior to action affects the way that visual and proprioceptive information is integrated.

Touch is always a big help when an activity is new for me. Only through practice and through the gradual fading of touch can the activity be done independently. I needed to be touched on my right shoulder for doing any new skill. So I consider that the touch method is a vital step to speed up my learning skill. --- Tito Mukhopadhyay

The reason people with autism repeat actions isn't simply because they enjoy what theyare doing. The repetition doesn't come from our own free will... itis more like our brains keep sending out the same order, time and time again. --- Naoki Higashida

These experiences are consistent with evidence that individuals with autism may have difficulty mentally disengaging from an object or choice, initiating and reducing automatic responses. An understanding of these challenges can be helpful simply by encouraging greater sensitivity to them. The following strategies may be helpful:
 

• provide regular opportunities to express choices

• vary the mode used to offer choices (verbally, using pictures, altering the number of choices)

• provide plenty of verbal encouragement (think about what you need, try again)

• to reduce impulsive actions, have the person pause before they make a choice or engage in a task (use your eyes, think about which one you want to point to).

• provide haptic feedback, modeling, or passive touch to support initiation of movement

• play to sensory strengths by enhancing auditory and proprioceptive input when a person with autism is making choices or transitions

Support Autonomy - Only After Communication

One big no, no. The pursuit of “functional skills” should NEVER take priority over teaching communication.

I screamed silently, make my mouth work as my hands; can you idiots not see my struggle to tell you I have so many answers to the questions you place before my face? Isn't tying the speech to my mouth from my brain more critical to life than making a piece of cotton secure? When I was 15 I tied my shoes and people rejoiced as if I had won an enormous prize in some battle... my mind believed this excited reaction to tying my shoes still foolish. --- Jamie Burke

Day to day living skills are certainly important, particularly selfcare. But efforts to teach various functional skills should augment, not replace, efforts to improve communication, broaden social relationships, support inclusion and enhance the quality of life of people with autism.

Choices

People with autism often experience a great deal of external control from others, without the ability to exercise the same choices that typical individuals ordinarily make. In many cases, oversight is necessary to protect against harm. Unfortunately, this oversight is often accompanied by controls and restricted choices that most of us would find intolerable.

Offering choices reduces behavioral problems, and increases motivation in educational settings and in daily living. Compared with nochoice environments, both the ability to choose between activities (e.g. learning something new versus baking a cake, listening to music versus playing a game) and the ability to choose within activities (photo descriptions versus typing practice) encourage less challenging behavior.

Most importantly, providing the ability to exercise freedom of choice is more than a behavioral strategy. It is a human right that supports autonomy and personal dignity.

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