The behaviours that children with autism exhibit are usually divided into two areas; excesses and deficits. We usually hear about these deficits as language, social skills, play skills, attention skills, self-help skills, and sensory regulation. The excesses are usually described as tantrums, aggression, stereotypical behaviours (stims), non-compliance, self-injurious behaviours, issues of sameness, and sensory regulation. I Can Too has 9 core areas that we focus on developing programs around that we feel cause, effect, or contribute to the deficits and excesses listed above. These areas are:
Cognitive Profile:
Children with autism learn differently than typical developing children. We know that autism is a neurological disorder but children with autism have the potential for normal intelligence. The way they look at the world, engage in the world, develop rules and boundaries with their environment, and their specific learning style should be a factor when developing programs for them. Their cognitive profile and intellectual abilities should drive the development of their program. Knowing typical child development and where each client lies in the developmental domains in relation to their chronological age, knowing the “type” of autism they have, and the impact and severity of their autism should always be taken into account through the time we are working with them. We must be able to change programs so they fit with each child’s cognitive profile so the program provides them the most benefit now and in the future.
Tangible Motivation:
We hear all the time that children with autism are more object oriented than people oriented. In most cases we also believe this is true, but their engagement with the objects or toys in their environment is still usually minimal or highly perseverative in nature compared to a typical child of the same age. For some children with autism, they will engage in every toy they see but their engagement may be highly repetitive from toy to toy (self-stimulatory), fleeting, and usually not very elaborative. As soon as a typical child can open and close their hand voluntarily, they will reach out and grab anything they can get their hands on. This is where much of learning starts. They feel it, mouth it and eventually bang it, throw it, push it, bang it with another toy, snap it together, build with it, pretend with it, and on and on. Typical children find reinforcement through exploring, trying new cause and effect relationships, problem solving, and they have significant motivation with novelty. Tangible motivation, or toy motivation, is the pathway to exploration. Exploration is the pathway of learning. If a child with autism has little motivation to engage with anything and everything around him, engages in a very repetitive manner with the toys in his/her environment, does not engage with novel toys, how is he/she going to maximize the learning opportunities from those toys and the environment as a whole. We need to get our kids motivated to explore, interested in novelty, and realize they can make anything and everything fun.
Social Motivation:
We at I Can Too truly believe that autism, in most cases, is primarily a social disorder. As stated earlier, children as young as two months of age are starting to observe everything and everyone in their environment. Once their motor skills develop so that they can imitate (as early as 6 months), they start to imitate all they see others doing. Since agenda-driven behaviours are a significant excess in children with autism, we see them rarely observing others in their environment because they are too much on their own agenda and isolated. Therefore, they are rarely imitating others in their environment. If you are not observing and you are not imitating, then you are not able to learn independently. It is very important to have a highly individualized program that works to remediate deficits, but developing motivation around social interaction, social initiation, and social elaboration through diminishing agenda driven behaviours is a must for long term and independent development. By working to get children with autism off of their own agenda through developing motivation to enjoy others, it is then highly likely that they will then observe and imitate those in their environment and engage in independent learning. Typical children seek adult interaction and are interested in what others are doing and saying. Typical children bring toys and other items to adults in an attempt to learn something about these items through observing and imitating. Since children with autism frequently do not demonstrate this curiosity or desire for new information, they are not able to acquire these skills on their own. As we increase the desire to socially engage with those in their environment and develop their ability to observe and imitate, children with autism have now accomplished some of the most important skills and concepts of independent learning. This is when we hear the parents of the children telling us all the new behaviors their children are exhibiting and learning outside of therapy sessions. What a great time this is!
Executive Functioning:
This refers to the capacity to control our attention and focus and to make organized decisions about our responses to the environment. It is cognitive flexibility, mental representation of tasks and goals, planning, inhibition, organization, self-monitoring, and set shifting. Executive functioning is the ability to consider alternatives in planning, calls for keeping a number of items in working memory, allocating attention to completing stimuli, balancing priorities, weighing the consequences of alternative courses of actions, considering available resources, and thinking of possible options before taking action. Executive functioning seems to be very difficult for most individuals with autism. All the things we do very easily like attending to incoming information, screening for relevance, integrating, organizing, drawing on that information in order to plan our response, and then acting accordingly, can be very difficult for a person with autism. Think of playing a game, putting on your shirt, washing your hands, or even sitting in a chair. All of these actions have multiple steps and although it is easy for us to attend and process the steps we need to take to accomplish the goal, when you have executive functioning difficulties these basic tasks are not that easy. There are close to 20 steps in washing your hands and close to 15 steps to putting your shirt on. Think of the planning and execution it takes to start, hold, and finish a conversation. Think of the ability it takes to sit in a class full of other children with information all over the walls, windows with children walking by, while listening to a teacher in the front of the class, watching her write, and having to follow along in a book on your desk. In many instances we see children with autism “walking” the room but never engaging in all of the stimuli (toys or people) in the room. It’s not that they don’t want to, it’s just too difficult to plan the process to do it.
Theory of Mind
Have you ever visited an under 4 and an over 4 year old preschool class? Children in the under 4 year old classes do not make decisions based on others needs, wants, desires, emotions, etc. but the over 4 year olds are starting to. There is a cognitive and learning process that children go through around the age of 4 and continues as they get older called Theory of Mind (TOM). TOM is the ability to take someone else’s perspective. There are a few levels of TOM but the beginning level is knowing that what you like, dislike, what makes you happy and sad, what makes you mad and excited, etc. does not necessarily do the same for everyone else. Just because I like chocolate chip cookies does not necessarily mean that everyone likes chocolate chip cookies. Children without TOM would believe everyone does. This is why when you hang out with children under 4 years of age you will often see them grabbing, pushing, and taking things from each other which continues with a blank stare on one child’s face as to why the other child is crying. Why is he crying when I am very happy that I now have the toy? If I’m happy, why isn’t he happy? Why isn’t the entire world happy right now? A child with TOM will not usually push a child down and take their toy when they want it, at least not when an adult is looking. A child with TOM will wait until the child is not looking and take the toy, he will bargain or trade with the child, or he will at least take the toy and run so he is not caught while the adults are asking the other child why they are crying. Also, a child cannot lie without TOM. As I said, there are a few different levels of TOM and it was used to be told that children with autism are “missing” a part of the brain where TOM develops. We know this is not true as we are able to teach TOM to individuals with autism spectrum disorders. However, without TOM children cannot make decisions based on others. They will only talk about what they want to talk about, they will not change their behaviours or think about how to act around others as long as they are okay with what they are doing, they will not necessarily ask others what they want to do or play, and they will most likely have a lot of difficulty understanding non-verbal language, facial expressions, and the emotional needs of others. Without TOM, children cannot change their own behaviours based on others perceptions of them.
Agenda Driven
One of the most significant excessive behaviors that interfere with learning for children with autism is that they are too much on their own agenda. If you are too much on your own agenda, too isolated, you are definitely not observing, imitating, or learning from all of the opportunities in the environment. Even if a child has a wide range of skills, often he will not use these skills to create learning opportunities because he is pursuing his own agenda. Children who are very agenda driven frequently do not check-in with the adults around them for approval or support. Much of this is the competition that we as parents, educators, peers, etc. are working against to develop learning opportunities. We need to get children with autism off of their own agenda, more on the rest of the world’s agenda, and this will lead way to more observation, imitation, and independent learning. If you are too much on your own agenda you continue to engage with the environment with minimal elaboration, repetitively, in ways that you cannot learn anything more, and you minimize your ability to learn from all of the other opportunities that typical children do learn from.
Overselectivity
Children with autism are often overselective in their environment, with people, with parts of things, and with non-salient information. Central coherence or integrating information into a meaningful whole can be missing. Children with autism spectrum disorders tend to miss the forest for the trees, or are overly focused on extraneous details. Therefore, understanding the big picture when it comes to play themes, stories, conversation, pictures, and other types of information may not be understood. As you can see, if you are overselective you may be missing a lot of opportunities to lean from the environment
Flexibility
Often children with autism have restricted interests, activities, and ways of playing and interacting with items and people. They may have certain activities they enjoy doing over and over, or certain topics of interests that will completely occupy their thoughts, and if able, dominate their conversations. In turn, children with autism quickly develop rules on how the world works that may be maladaptive and then become rigid around these rules. They will have considerable trouble shifting their attention from one topic to another or following a conversation where topics change rapidly. It is important to teach flexibility because often despite structure and schedules, routines change. Children with autism need to be able to adapt to new situations, new ways to explore activities and toys, and interruptions in their typical schedule. However, you cannot blame children with autism for being so rigid. Think about it, what if you have little understanding of language, you have significant difficulty communicating your wants and needs, you do not have many play skills to take up your time, you lack social skills so you do not engage with others, you have difficulty with sensory regulation, and everyone is pulling you this way and that. Think of how anxious and stressed you are everyday, all day. Everyone needs predictability and if the world is complete chaotic to you on most days, becoming rigid and “inflexible” so there is some predictability and stability in your life is understandable. Although some level of rigidness is acceptable and does not interfere with daily learning, excessive rigidity will definitely minimize your ability to learn appropriately.
Sensory Regulation
Children with autism can be easily overwhelmed by their senses. When this occurs, they may miss information being given to them because their attention is too focused on the sound, smell, taste, or feel of something. For instance, a dog barking down the street may be such a distraction that the child cannot hear anything said by the teacher right in front of him. They may be hypersensitive or hyposensitive to many senses and they can actually fluctuate day to day for some. One or more of these senses may dominate their attention, not allowing them to focus on anything else. Often children with autism cannot gauge exactly what is going on around them, and how to act accordingly, because they are unable to integrate the sensory information from the different sources around them. We need to understand that our central nervous system regulates us. It regulates our touch, how our muscles receive input, our balance and head in space, our vision, our hearing, our smell, and our taste. For most of us throughout the day, we may become disorganized by environmental stressors, however we are able to consciously or unconsciously seek out sensory stimulation to help our nervous system regulate us. We have a large area of “regulation” that as long as we stay in that area we do not need to seek additional stimulation. However, when we become too hypersensitive or hyposensitive, we need to consciously seek out additional stimulation to feel regulated. We will stretch, we will walk or exercise, we will curl up in a blanket, turn on the T.V. or radio, eat, drink, etc. We will continue to consciously seek additional input until we feel regulated again. Now think about your comfortable “area” of regulation is very small and you are constantly battling feeling regulated. Although most typical individuals will seek appropriate ways to regulate themselves, children with autism will find any way possible to regulate themselves the quickest. We believe, among many others, that this is where many self-stimulatory behaviors originate from. We believe that stopping children from self stimulating without redirection into an appropriate activity or source is inappropriate. We need to teach them and provide them with more socially appropriate behaviors to regulate themselves. Think of a person holding your hands down every time you try and stretch. We cannot just stop children from seeking input and expect them to be fine with it. But, we also need to make sure that the way they are regulating themselves is socially appropriate. To assist our nervous systems in maintaining an optimal level of alertness we need different types of sensory motor experiences. Many times a child with autism will avoid certain types of stimulation. For example, they may avoid a change in head position, movement of their feet off a stable surface or certain textures of food in their mouth because it is disorganizing to their system and can cause their nervous system to be stressed. Our goal is to make neurological changes to allow the child to organize all of their sensations for use to help them focus on age appropriate functional activities.