Tag Archives: autism

Helping Children with Autism Build Skills as They Grow Up

autismAt its core, autism spectrum disorder (ASD, or autism) is a social disability that is present across one’s lifespan. Areas of difficulty and goals for treatment evolve as the child with ASD grows older and social interactions become more complex.

Social skills are highly nuanced and difficult to measure, but one thing is clear; early diagnosis and treatment help. With an infant or toddler, red flags for ASD can include failure to make eye contact, point to or express interest in objects, engage in social games like peekaboo, or use simple language to request, comment, and make social initiations. Although developmental delays are not always symptoms of ASD, concerned parents should seek guidance from their pediatrician. Treatment for young children typically involves using rewards to motivate and reinforce specific skills and behaviors, such as pointing, vocalizing, or making eye contact.

Building skills as symptoms change
As children grow up, the social demands of the world change and become more complex—we expect different skills from a 12-year old than a three-year old! Verbal skills become increasingly important; the give-and-take of conversation with friends that most of us take for granted is tough for them to master on their own.

Children with ASD may be able to hold a long conversation about a topic that interests them, while friendly chatting and two-way conversations on subjects they find less interesting could be a challenge. Progress can be complicated further by difficulty picking up on more subtle, nonverbal cues, such as recognizing when a friend is bored or annoyed by reading his facial expressions and body language.

The importance of teamwork between children, parents, and clinicians
This is where parents and clinicians can help. As children with ASD grow up and face escalating social demands, they benefit greatly from working with a clinician who can measure progress, assess areas for further development, and establish and adjust individualized, incremental, and achievable goals. Parents are a critical component of progress and can be great social coaches for their children.

The Child Study Center
The Child Study Center, part of Hassenfeld Children’s Hospital at NYU Langone, offers a number of evidence-based programs that help children with ASD improve their social skills at each stage of development. All of these programs include an equally important parent group.  We know that parents are by far the most important supporters and coaches for their kids, which is why the parental component is the highlight of our group programs. While the children learn skills through lessons, in-class practice, and homework assignments, the concurrent parent programs show parents how they can reinforce their child’s social development at home.

Children learn social skills at different rates, but as with any skill, the more practice, the better and faster the progress. We encourage parents to make sure that their child has an abundance of opportunities to practice and develop these skills in their day-to-day lives.

For more information on the Child Study Center’s social learning programs, email us at csc.sociallearning@nyumc.org or call 646.754.5284.

April is National Autism Awareness Month. Learn more online at the Autism Society.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Rebecca Doggett, Ph.D. is a clinical assistant professor of Child and Adolescent Psychiatry at the Child Study Center at Hassenfeld Children’s Hospital at NYU Langone.

 

Helping Your Child Make and Keep Friends

friends

Friendship is protective—having just one or two friends can make all the difference to a child’s development. Friends increase self-esteem, confidence, and independence. Having friends can also protect children and teens from bullying and victimization, and help buffer the impact of stressful life events.

But for some children and teens, making and keeping friends isn’t easy. Whether due to anxiety, ADHD, autism, or developmental disabilities, some lack the confidence and social skills needed to make a phone call, join a conversation, or play team sports. They may not pick up on verbal and nonverbal cues or empathize with others’ perspectives. And the consequences can be considerable: loneliness, depression, anxiety and isolation. This inevitably spills over into life transitions, including college, dating, and finding and keeping a job.

Fortunately, these skills can be taught. One place to start is building conversation skills including trading information with the goal of finding common interests, sharing conversations, and building awareness of nonverbal communication skills such as making eye contact and having good body boundaries. Another starting place is helping children and teens to choose appropriate friends by identifying a peer group and identifying extracurricular activities to find sources of friends who share common interests as a basis for building friendships.

The Child Study Center at NYU Langone Medical Center conducts social skills classes for children as young as three through young adults up to age 30 to help teach these skills. Our clinical faculty and staff use evidence-based interventions, the Children’s Friendship Program for elementary school children, and the PEERS® program for teenagers and young adults. The children, teens and young adults learn skills through in-class rehearsal and homework. It is a class; it is not a place to make friends, but a strategy on how to make friends in their real, outside lives.

The classes are developmentally appropriate for each age group. The youngest children learn how to play in groups. Elementary school children practice face-to-face conversations, make phone calls, and learn how to handle rejection. Older teens learn dating skills—how to ask someone out, how to behave, and what behavior is acceptable. All groups have homework, which involves practicing their new skills. This homework helps children gain confidence and solidify their new skills.

Parent participation is integral to the program’s success. In separate, concurrent classes, parents learn the language and skills being taught to their children—a requirement that not only enables them to help their children with homework, but also gives them the tools to be social coaches long after the program is over.

Each group meets weekly, for 60, 75 or 90 minutes, depending on age.
•Preschoolers attend 60-minute sessions for 15 weeks.
•Elementary school children between the ages of 5 and 8 attend 75-minute sessions for 12 weeks.
•Elementary school children between the ages of 9 and 10 attend 75-minute sessions for 14 weeks.
•Teens from 11 to 17 attend 90- minute PEERS® program classes for 14 weeks.
•Young adults with autism from 18 to 30 attend 90-minute PEERS® program classes for 16 weeks.

We perform an initial screening of all applicants and then meet with each child and parent to see if the child is appropriate for the group. Minimum requirements include approximately average cognitive and verbal functioning; a parent willing to participate; English language knowledge; and the child’s expressed interest in making and keeping friends.

Manhattan groups are conducted at One Park Avenue, 7th floor, New York, New York 10016. For more information, please call 646-754-5284 or email csc.sociallearning@nyumc.org.

For group offerings at our Long Island campus in Lake Success, please call 516-358-1808 or email Bonnie.Schwartz@nyumc.org.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Sarah Kuriakose, PhD, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry and the clinical director of the Autism Spectrum Disorder Clinical and Research Program at the Child Study Center at NYU Langone Medical Center.

Sarah Kern, LCSW, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry at the Child Study Center at NYU Langone Medical Center.

A Picture’s Worth a Thousand Words: Creating the Perfect Visual Schedule for Your Child with Autism Spectrum Disorder (ASD)

asd

Establishing a predictable and structured daily schedule for your child with Autism Spectrum Disorder (ASD) can make a huge difference in her ability to meet behavioral expectations throughout the day. Unexpected changes in schedule may be upsetting and trigger challenging behavior that impacts the whole family. Follow these simple steps to create a thoughtful daily schedule:

1. Review your child’s daily activities: Begin by writing out your child’s activities on a typical day. Make note of the activities that are associated with challenging behaviors and focus on those activities first.

2. Choose prevention strategies that make sense for you and your child: Consider whether any of the following strategies could be used to prevent problem behavior from occurring.
• Reorder activities: Sometimes children engage in their most naughty behavior when they are asked to stop a favorite activity and transition to a nonpreferred activity. For example, a child might scream and protest when his father asks him to turn off the TV and begin homework. To prevent challenging behaviors that arise during these difficult transitions, simply reorder the activities (i.e., ask him to complete his homework and then offer TV time as a reward).
• Provide warnings: To reduce challenging behaviors associated with transitions, use visual and auditory cues to remind the child about the upcoming change in activities. Setting a timer that signals the end of activity at the 10-, 5-, and 2-minute mark—or simply stating the remaining number of minutes left in the activity—will prepare them for the end of the activity.
• Change the timing of activities: Children may engage in challenging behavior when they are asked to do a difficult task in a short amount of time. If your child engages in disruptive behavior when he is asked to quickly pick out his clothes in the morning, have him complete this activity at the end of the day, when he has more time and there is less pressure to get out the door and catch the school bus.
• Modify the environment: Children sometimes become more distractible when tasked with activities that require sustained mental effort, such as homework or practicing an instrument. Help minimize distractions for your child by creating a distraction-free zone for activities that require continued attention (e.g., provide a quiet work space away from siblings, give your child special headphones, remove technology from the room).
• Build in breaks: If your child engages in problem behavior or is very active when asked to sit down and complete schoolwork, schedule short breaks for her in advance. For example, after completing 10 math problems or engaging in 15 minutes of homework, provide your child with a 2 minute break. During breaks, encourage your child to do something relaxing, like look at a book, or release energy through short exercises or games, such as jumping jacks or a quick round of Simon Says.
• Establish routines: Creating daily routines for activities that are associated with challenging behaviors may help increase compliance and independence with daily living skills. For example, many children demonstrate behavioral difficulties surrounding bedtime; establishing a bedtime routine that incorporates 4-6 steps, which may be completed in the same sequence each night (starting with the more demanding and ending with the more enjoyable), will help your child learn the expected and appropriate behaviors.

3. Set up a visual schedule: After you have developed the schedule of activities for your child, you can create a visual schedule with basic art supplies (e.g., foam board, markers, and Velcro) or on the computer that may be shared with him. Visual schedules promote predictability and increase comfort and independence with daily activities. You can draw pictures of the activities, take photos, or find images online—incorporating simple pictures into the schedule may increase your child’s understanding of the behavioral expectations and the appropriate sequence of activities. Print the pictures, laminate them, and apply Velcro to the backs so they can be placed on the board.

4. Introduce the schedule to your child: Decorating the schedule with your child can be a fun way to introduce the idea. Gather some art supplies that she enjoys and encourage her to make the schedule her own.

5. Post your schedule in a high traffic area: To maximize the impact of the schedule, find it a good home! Posting the schedule in a place where you and your child spend time regularly, such as the kitchen or his bedroom, will facilitate greater exposure. Be sure that the schedule is at his eye level so he can reference it with ease throughout the day.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Rebecca Shalev, PhD, BCBA, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry at the Child Study Center at NYU Langone Medical Center.

Supporting Young Adults with Autism through Life Transitions


The transition between high school and college or high school and other postsecondary opportunities brings a lot of changes to the lives of young adults and their families. In most cases, young adults suddenly experience much more flexibility in terms of daily activities and schedule—and unfortunately have fewer opportunities for structured social activities. For adolescents and young adults with autism spectrum disorder (ASD), such transitions can be extremely difficult due to their specific social challenges. Such challenges may interfere with the ability to successfully form friendships and romantic relationships, navigate college, and later on, seek and maintain employment.

Parents play an important role as social coaches and facilitators of vocational and social opportunities. Below are some suggestions for parents for supporting their adolescent or young adult through the transition to adulthood and toward independence.

Make a Plan

Identify goals
Adolescents and young adults tend to show interest in employment opportunities, greater independence, and social relationships, including romantic relationships and dating. If having close friends or dating is a priority to your child with ASD, it’s important to think about how to intentionally build in more support and social experiences to help him or her to be successful and included in his or her community.

Start small
Parents and young adults don’t need to do everything all at once! Once goals are identified, think about priorities. If the goal is to make new friends and build one’s social group, work with your young adult to identify his or her interests and find social activities or groups based on those interests. For example, if your child has an interest in chess, he or she can visit gaming stores, attend tournaments, join a chess Meet Up group, or join a chess club on his/her college campus. It can be helpful to talk about how to identify individuals who may have similar interests. If the primary goal is employment, starting small may include one of the following: visiting a parent’s place of work for a day, participating in extracurricular school activities related to career interests, learning about internship or service learning opportunities, or occupational mentoring to learn and practice work behaviors and gain awareness of a potential professional niche.

Practice together
In addition to the two planning steps above, a helpful tool for young adults is practicing the different skills or scenarios that might come up in vocational or social situations. Try role-playing interview skills or having a back-and-forth conversation, and give your child feedback or coaching. Common difficulties for individuals with ASD that may need coaching include inconsistent eye contact, dominating the conversation, perseverating on topics of personal interest, talking about inappropriate topics, and body boundaries.

Praise/recognize efforts
Individuals with ASD may feel misunderstood or disrespected, and become exhausted by social demands, or think of small talk as phony. It is important to praise their efforts and motivation, while continuing to coach around areas of difficulties.

April is National Autism Awareness Month. Learn more online at the Autism Society.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Katherine Sullivan, PhD, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry at the Child Study Center at NYU Langone Medical Center.

Your Child Has Autism: Now What?


Your child has just been diagnosed with autism spectrum disorder (ASD), and it may feel as though the ground has dropped out from under you. The challenges seem overwhelming at first, but you don’t have to face them alone. With so much going on, it can be hard to know where to start. Here are a few ideas.

Find Professional Support
You are beginning your journey as your child’s advocate and will need to identify the resources you need as soon as possible. Your child will have symptoms, abilities, needs, and challenges that are unique to him or her. With that in mind, a little research will help you evaluate who can best help your child. Be sure to ask questions about each therapist’s approach and methodology, including whether the treatment is grounded in evidence-based practice and how parents and caregivers are included in the treatment.

Make Time for Yourselves
Your child’s needs are paramount, but if you are going to be able to meet them, you must also take care of yourself. As parents, you are under a tremendous strain. It’s critical that you take a deep breath, step back a bit, and process your own emotions and needs. It will be hard at first—your impulse will be to throw yourself into protecting and helping your newly diagnosed child—but it is necessary for your own long-term health and that of the rest of the family.

Be Open with Your Other Children
The diagnosis affects the whole family. Your other children will have questions and reactions, and their feelings about having a sibling with autism need to be validated. Don’t withhold information—it will neither protect them nor make them feel better. Encourage them to ask questions, and process what the diagnosis means for them.

Build a Support System
Don’t go it alone. It’s impossible to overstate how important it is to have family, close friends, parents of children with ASD, and therapists who support you as you start on this new path. Other parents will be particularly supportive—who else knows truly understands what you’re going through? They can be an invaluable source of information on family dynamics as well as on therapists and other resources.

Approach the Internet with Caution
While the Internet is a great source of information, it also contains a great deal of misinformation; you must be discerning. When reviewing websites, check to see if the author has a background in ASD and is professionally qualified to provide reliable information. Also, note whether the site’s information has been subjected to rigorous testing and research. Put another way, does the site share information on evidence-based practices?

One last, but important, note. Your child is the same child he or she was before the diagnosis and will continue to develop in his or her own way, and build unique strengths, skills, and interests for you to embrace and celebrate.

April is National Autism Awareness Month. Learn more online at the Autism Society.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Sarah Kern, LCSW, is a clinical assistant professor in the Department of Child and Adolescent Psychiatry, at NYU Langone’s Child Study Center.

Safety First: Teaching Safety Skills to Children with Autism Spectrum Disorder

Child holding father's hand
If you have a child with autism, you know that safety skills are a primary concern. Your child can encounter situations every day—like crossing the street—that might pose a risk, or they might engage in dangerous behaviors such as wandering. It can be hard to know where to start when it comes to teaching your children best practices to avoid or how to respond to unsafe situations, but the strategies below can be applied to many common safety concerns that arise. Think about applying these steps to the scenario of your child getting lost in a store.

1. Assess: What is the safety issue? What does your child know about the situation?
Your child tends to wander or get separated when you’re shopping in a large store and you want to create a plan for what to do in that situation. Right now he doesn’t know who to seek help from or what information to give him if he gets separated from you.

2. Plan: Create a strategy for dealing with the safety issue at hand if and when it occurs.
In case of separation, make sure your child knows his full name, parents’ names, home address, and telephone number. If your child has very limited language abilities, he should have an ID card or bracelet with him at all times. If he gets lost in a store, he should go to the person or people you have indicated are safe to go to for help—e.g. police or security.

3. Teach a plan: Talk to your child about how she should behave in the situation.
Speak to your child about what might happen if she gets separated from you at the store. Explain how to respond when people call her name and to listen for an announcement on the loudspeaker. Also make sure she knows who to ask for help and to stay in one place if she can’t find help. Many children with autism respond well to having concrete rules and steps to follow.

4. Model appropriate skills: Demonstrate skills or activities in action using social stories, pictures, videos, and other helpful teaching tools.
Show him pictures online of the types of people he should ask for help (e.g. police, firemen, security). You can demonstrate the steps for him at home: pretend you are a lost child and go through the steps. You can also find videos online that demonstrate what to do when lost in a store.

5. Practice: Practice putting your child in the situation—in a safe, controlled environment—and allow her to practice the new skills in many different natural settings.
When you’re at a store, have your child point out people who could be helpers. Have her repeat what she would say to someone if lost, such as “I can’t find my mom, can you help me?” Then set up a realistic drill. Give the security guard at a store you’re familiar with a heads up that you’ll be practicing. Stay within earshot of your child—but not with her—and have her go through the steps you’ve explained. Generalization doesn’t occur easily, so repeat in a variety of settings with different kinds of helpers to ensure she can demonstrate her skills in unfamiliar situations.

Reward/give feedback: Praise and reward your child when he gets the skill right. You can gradually phase out the reward system as the skill becomes well-learned.
Tell your child how well he followed the steps of your plan, provide additional teaching where necessary, and reward attempts at learning new safety skills.

The most important step is to practice, practice, practice! Not only will it help your child stay safe, but it will help your peace of mind to know he has the skills to manage the situation.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Rebecca Doggett, Ph.D. is a clinical assistant professor of Child and Adolescent Psychiatry at the Child Study Center at NYU Langone Medical Center.