1. Decide what the most important change should be (paint color, replacing furniture, buying a new bed).  Make changes in order of priority.  It’s not always necessary to do everything at once.
2. Use search engines!  Find discount stores, estate sales, flea markets and all types of swap meets, second hand stores and internet savvy to enhance the overall selection process.
3. Research major shopping websites for simpler pieces of furniture. Call them (yes, there are still brick and mortar stores, and some even have well-informed salespeople or managers.)  Inquire as to when seasonal “on display” furniture items go on sale. In all home furnishing store, there are often discontinued floor items that they will sell at extremely discounted prices.
4. If you need a new throw rug for your wood or cement floor, but don’t want to spend the money, believe it or not, you can generate a chic, expensive looking design with paper, pencil, scissors and some paint! Simply enlarge the pattern to the size you desire on a photocopier (just use a sturdy paper) cut out the pattern and viola’, instant stencil! Then tape it on the area of the floor you want for your design.  Get a paintbrush that fits the design and paint your selected color or stain over the stencil.  Wait a couple of hours and then remove the stencil.  It really does work!  Just make sure that the floor material won’t repel your paint /stain selection.  This process tends to work best on wood and cement flooring.
5. If you want new curtains or window treatments but want to avoid the extra cost, try the do-it-yourself method.  Shop at fabric stores for bolts of material or purchase some nice flat bed sheets.  Get an inexpensive curtain rod from a home improvement store and you’re on your way.  Cut the material to size, wrap it around the curtain rod in any way you want allowing it to hang straight down or use thin strips of any favorite material as sashes to tie or knot your curtains to the side.
6. If you want something resembling a decorative valance, use the aforementioned stenciling process again.  It works on walls too!  Just remember to focus on what your child’s needs are.  It’s easy to get caught up trying to be creative and elaborate. The phrase “less is more” couldn’t be more appropriate then when designing your child’s personal atmosphere.
7. Try taking a swatch of patterned fabric or even gift wrap, (yes, attractive wrapping paper) and cut it into a stylized shape.  Matte it and frame it just as you would a picture, and you have an interesting designer accent for any room.  This is particularly useful for providing imagery your child would favor, but would be inappropriate to incorporate on a large scale.

These may seem like very simplistic suggestions, however, they are all low cost, artistic, innovative, one-of-a-kind, “green” ideas you can use within the design of your child’s room as well as your home.  Now, hopefully, you’ve begun to understand how to address many of your concerns without feeling overwhelmed or intimidated.

Conclusions

Now that we’ve discussed how to evaluate your child’s needs, understand the purpose of the room you want to re-design, anticipate the effects of various colors, and consider spatial organization, my hope is that you feel you have been armed with some fundamental tools that will motivate you to jump on the “do-it-yourself” bandwagon with excitement and a renewed sense of confidence and control!

These guidelines should help you take back some control and become inspired.  You can employ your personal imagination, inspiration and newly acquired knowledge of your child’s needs to make a positive change to their environment, and subsequently make a significant impact on the quality of their life.  When these methods are used to their greatest effect, you may observe a noticeable change in the way your child behaves and interacts with you, the rest of your family, and the world around them.

Experiment, observe, learn, and enjoy the process of improving your children’s space and any other part of your home.

Just remember, no matter what you choose to do, always begin With a Brush of Love!

© Lauren Henry

In order to achieve music’s most positive benefits it is important for the music educator to provide a well-framed music lesson.  This lesson’s primary intention should be establishing a strong connection between student and educator.

Adamek and Darrow in the book Music in Special Education offer us some great tips on how to provide such a session framework. Here are 5 variations on their suggestions.

a)    be aware of your PROXIMITY.  Pay attention to how close you can be near your student and aim to be as close as possible without causing any anxiety or even mild discomfort.   This gives the student a feeling of support without being touched, and assists them on staying on track.

b)    Present your lesson concretely and SIMPLY.  As mentioned last month when introducing a new piece to your student play it through in its entirety and at speed.  It helps the student if their ear has been trained to the sound of the final product.

c)    Although each lesson will have unique content, it is important to keep the same FRAME for each lesson allowing the child and educator to experience greater success.  For example start with a familiar greeting and move into a review of the previous weeks lesson, go over new material and then end with a regular and familiar closing.

d)    Having a CUE for anticipated “trouble moments” such as when a student starts losing focus or goes off track of the designed session. A cue can be a quick way to bring the student back to the tasks at hand.  Cues can be auditory or visual or a combination of the two.  And finally;

e)    Include a time of FUN in each session.  Just improvising and playing together can open a conversation between the student and teacher  – music can speak more than words.

My company has a long standing client who during his music therapy session would often begin to sing the familiar game show Jeopardy theme song….and would move towards this song at every opportunity. In speaking to my colleagues and in some of the readings I have done this is described as common during a child with autism’s music therapy session or music lesson. Children with autism may gravitate towards snippets of songs or songs in their entirety from game shows, movies or video games.  From this starting place it is suggested that the teacher or therapist gradually decrease the usage of the student’s preferred musical interest (ie. the game show theme song) and introduce variations to the theme in the form of improvisation.

Suggestions include: stay in the mode but move around the piano (or other instrument), change the rhythm or introduce a new timbred instrument.  The long-standing client above has transitioned very well into new musical improvised conversations – albeit over time.

Adamek and Darrow remind us that “each student is an individual with specific needs and abilities that equip the teacher to develop the best educational strategies possible. The best action that music educators can take is to seek out professional growth and learn how to effectively adapt their instruction for students with disabilities based on their needs and abilities.”

Good luck and thanks for teaching our young people.

© Jennifer Buchanan

If you’ve been following my articles, you’re already familiar with my passion, and the focus of my business, With a Brush of Love. It is our mission to make a significant impact upon the lives of children with special needs and their families by creating unique environments that support their specific needs. Something I try to do with each project is to inform the parents, family members, and sometimes teachers and counselors, that children take time to acclimate to their new environments. It’s difficult to predict how long it will take for the benefits to be realized. It can take as long as several months, or as little as a few days. Once in awhile, however, something extraordinary occurs. That’s what happened last week, and I want to share the exciting and uplifting experience of the Davis family with you.

I just returned from US military base, Camp Foster in Okinawa, Japan. I was fortunate enough to have been invited to give a seminar for parents on design techniques for special needs children. As part of the presentation, I was asked to redesign the bedroom of a 2yr old boy named Merrick who was just recently diagnosed with autism. His parents are Marine Sgt. Garey Davis and his wife Kristen.

As one would guess, we conversed for quite some time, discussing various concerns and challenges the Davis’s faced daily. I learned what their primary goals for Merrick were, as well as their goals for their family as a whole. As they explained their concerns as well as Merrick’s challenges, we developed a strategy and design for his needs while adhering to the constraints of their home on the military base. One key factor was accommodating the need to replicate the design in another home when they need to dismantle and relocate, as military families so often must.

Upon arriving in Okinawa and finally meeting the Davis family face to face, their stress and concern were clearly visible. Neither of them had been able to sleep consistently over the past several weeks due to Merrick’s restlessness. To make matters worse, Mommy was pregnant and was beginning to show, and they were planning on moving Merrick into a larger bedroom. The anxiety was taking a toll on all of them, and perhaps worse, affecting their relationship.

Merrick is only two and is a somewhat outgoing toddler with very little verbal communication. He does respond to some sign language and clearly understands everything that’s being said to him. He has exceptional fine motor skills. While he will respond to affection from loved ones, he rarely initiates it. He tries earnestly to express himself; he tightens his fists gasping with excitement and smiles when he’s feeling happy, and scrunches up his face when he’s feeling frustrated. He’s not the least bit shy. By all accounts, Merrick is an incredibly expressive, exuberant and loving boy. He’s presently unable to verbally communicate and socially interact like many other toddlers.

What I explained to Garey and Kristen was that his issues, his inability to sleep soundly and unpredictable agitation, were exacerbated by his surroundings. Our goal was to change that. The design process was complicated by the fact that Merrick and his family live in Okinawa, while I reside in Los Angeles. Interaction with the child and the family is an important part of what I do. We had to do the best we could with telephone and email interaction. The process was further complicated by the fact that almost nothing we would need was available in Okinawa. We had to acquire furniture, paint, window treatments, bedding, a rug, and even lamps here in the U.S. and ship it all overseas. Last but not least, we had to deal with the fact that we would only have two days in which to do all the work. However, with many hours of conversations and dozens of emails, we were able to communicate thoroughly about Merrick and come up with a plan of attack. With the help of numerous volunteers on the base and some fabulous representatives from the military’s Exceptional Families Member Program, anything was now possible.

Re-designing a space is not unlike putting together a puzzle. Every aspect of the room, from color to lighting, window treatments, bedding, furniture, plants, rugs, pillows (all the accessories) even sounds and scents must work together to form a complete picture. When everything is right, you can make a substantial difference for the child. The challenge is determining what the final picture should be. The child’s needs are the only guide we have, and those needs aren’t always as clear as one might think. In Merrick’s case, his parents were able to observe and understand his behavior and reactions very well, which made it much easier to design.

Through meticulous advance planning and a valiant effort from all involved, we painted Merrick’s new room with a soothing shade of zero VOC paint, added a black wood bunk bed, a rug to help absorb sound, dimmable lamps to control light, window treatments and various other touches. We included his favorite chair for comfort and familiarity. (the description of each item and why they were selected are rather extensive but can be seen in the next few weeks on my website www.brushoflove.com)

When Merrick entered his new room for the first time, he immediately walked to the middle of his rug, jumped up and down; and turned in circles clapping continually and smiling incessantly. He then jumped into his new bunk bed and got right under the covers. This was extraordinary because according to his mother, he had never gotten into bed of his own accord and hated anything that covered him. He then got out of the bed, ran over to both mommy and daddy separately jumping into their arms hugging and kissing them, something else he apparently had never initiated on his own before. He leapt onto his favorite chair dangling his legs across the arm, brought his prize truck into his bedroom (rather than his former bedroom which was now a playroom) and happily settled right into his normal playing routine. He lay down on the new rug and moved his legs and arms back and forth exploring how it felt. He jumped back into his bed, putting his hands behind his head, sprawling out under his unfamiliar covers , holding the comforter next to his ears enjoying the sounds it made beneath his new duvet. Then he jumped back into his parents’ arms, hugging and kissing them again. It was almost like he understood what they had done for him and what it meant, and that he was desperate for them to know how thankful and relieved he was.

I must admit, while I was thrilled, I was a little concerned that this reaction might not last. It’s not always typical for a child to respond so quickly and be so unusually demonstrative. However, in the two weeks since I’ve been home, Kristen and Garey have reported that Merrick’s response to his room and the shift in his behavior has not waned but rather continued and even improved. He now sleeps through the whole night. In the morning, when they wake him, he is calm and peaceful, whereas in the past he woke grumpy and anxiety ridden. Kristen told me, “It was like he was on medication; he was so much calmer and loving towards us – so much easier to deal with on all levels. We never realized how much stress we were under or the amount of sleep we had lost.” For the last few nights, Kristen and Garey have had alone time to talk and simply lie in bed together without Merrick waking up and becoming overly agitated and anxious. They were shocked not only by the difference in their son, but by how they felt themselves in his new bedroom.

The entire experience was a true honor for me and my company. I felt compelled to share this wonderful and uplifting experience, hoping that if your situation is similar to that of Kristen and Garey, perhaps you can feel empowered to make a positive change. While the speed of Merrick’s immediate response may not be typical, his general reaction is indicative of the importance of a healthy, supportive environment for a special needs child. Remember, whatever changes you make, always begin With a Brush of Love!

However, even with years of experience there may come a time where a new student presents a new consideration, taking the most veteran of teachers on a new learning path. This short article is to offer support to those teachers who are willing to take on the challenge and joy of serving a child with autism who also has the desire to learn music.

Teaching music to a child with autism requires a special skill set which is not typically acquired at teaching school. However Dr. Pamela Heaton, in Science Daily on May 27, 2004 determined that “individual music lessons could hugely benefit children with autism.” She went on to explain that “our research shows that even special needs children without special talents (musical savants) and no musical training can have highly developed musical “splinter skills.” These splinter skills can be defined as talents that may not always present themselves in just the musical context but in other areas as well including strength in organizational patterns, imitation skills and pitch identification.

When a parent witnesses their child’s natural affinity to music the quest for finding a suitable teacher commences and the following question may be repeated many times on the phone – ”will you teach my child music? She has autism and really loves it. Sometimes this question is met with great enthusiasm but more often than not silence on the other end of the phone is a more common response.

There are but a few resources that offer music teachers support when teaching a child with special needs. I have reviewed some of these resources and have also sprinkled in some of my own experiences in order to answer some of the most common questions asked by families and teachers.

What are the biggest challenges for the teacher when teaching music to a person with autism?

- handling behaviours of the student, including but not limited to tantrums and low concentration. Often the parents are the greatest resource here. When such behaviours are observed asking the parents what typically happens in their home setting, and what works the best, can be of great use to the teacher.

-knowing the best training method for their student. Like all students some learn better in certain styles than others. Some children with autism are strong visually and by using colours for notes or pictures for what is coming next works best. For some students listening to the teacher play the piece in its entirety before they even embark on the learning process works well. And for our kinesthetic learners they often need to physically experience everything about the music from playing the rhythm on a drum, to learning the notes on the keyboard, to marching to the timing of the piece.

What are the benefits of music based education for a person with autism?

- Music is a natural reinforcer and motivator. Parents have commented frequently on the increased attention their child has had during music therapy or music lessons in comparison to other learning environments.

- Music can tap into the person with autism’s strengths including their precision, pitch and organization.

- Music education increases a student’s instruction time during the day. With its abilities to motivate, music helps to develop many areas of the brain including where students develop their mathematics skills, language, and comprehension.

What are the challenges for the student during their lessons?

- Some students may have a unique sensitivity to the music itself (the actual tone, or sound of a particular instrument). It is important that the teacher is sensitive to such issues and adapts their sessions so not to pose harm to the student.

- Some students have a unique ability such as being able to imitate anything. Where this can become a challenge for the student is when they are asked to modify a certain section of the piece (speed up, soften, change a note). For these students it can prove helpful if the teacher plays the song the way they hope to hear it at the end of the learning. This first auditory experience can be incredibly helpful to the student in their process for learning.

FIVE STRATEGIES FOR THE TEACHER:

1. When introducing a new piece of music, play it through in its entirety – up to tempo and with all the dynamics and flourishes you hope to hear at the end of the teaching experience.

2. Break down the lesson into small segments (ie. Taking the instrument out of the case, opening the piano lid, reviewing the previous week’s lesson etc.) Use a picture board to reflect the 5 – 6 segments in every music lesson. Having a regular and familiar opening and closing is really important for framing a successful lesson. However for diversity you may want to make changes to the framework every school year or perhaps every season. Just remember to give the child a warning notice that changes are coming…3 weeks from now, 2 weeks from now, next week….

3. Include free time – this can be a time to move, improvise, sing, stretch, listen to a song on CD.

4. Have a trigger for when things are going well. This could be a phrase that the teacher says and only saves for such occasion, a certain shaped sticker, a different colour that you write a note in their journal etc.

5. Use hand gestures to move you through the piece instead of a metronome. This creates a more relational experience and keeps the student involved with not only the music but with you as teacher.

6. …and a bonus…enjoy the little moments and know that you are contributing to a child (and their families) life in a positive, meaningful way.

______________________________________________________

Some of the information collected in this article came from the following recommended resources and videos that I hope will inspire you as well: Adamek, M. S. & Darrow, A. (2005). Music in special education. Silver Spring, MD: The American Music Therapy Association, Inc

http://www.music-for-music-teachers.com/autism.html

Please send me your comments and additional suggestions for Music Teachers and their Pupils to buchanan@jbmusic.ca.

Goal setting processes need to include incremental steps that can be understood by the child.  Over-focusing on the achievement of the goal can overshadow the importance of what is learned by the child in the steps leading towards goal achievement.  The steps should be 1) visually clear, 2) at the appropriate cognitive level, and 3) within the current physical and emotional profile of the child.  The mastery of the steps that lead towards goal fulfillment increases self-esteem and competence, which are essential components of becoming an initiating, more independent person.

Obstacles to Developing Independence in Children with Autism

The difficulty in developing self perpetuating skills of independence for autistic children can be explained by understanding how the core deficits of the disorder affect all necessary capacities to be independent.  The developmental areas most affected by autism are 1) language and communication, 2) social functioning, and 3) cognitive functioning.  These reduced capacities limit or nullify the child’s ability to tell others what they want or need, inhibit feelings of empathy towards others, and limit independent problem solving skills.  Those limits, in turn, affect the child’s ability to develop a plan that leads to action.  It is important, therefore, for teachers, therapists and parents to develop processes or systems that take the child’s deficit areas into consideration when setting goals for independent functioning.  For example, if the goal for a child who has motor planning and sequencing problems is to be able to sit down at their desk and independently take out the appropriate supplies to start a task, the process should include incremental steps that lead to independence such as:

• Using a series of pictures which show the child doing each step of the task
• have the child watch  another child model the action,
• have the child read  directions about what to do from a cue card,
• have the child take out one item at a time and build up to more steps
• Have the child name the items he or she needs,
• have the child point to each item (with or without language)
• Use signing to guide actions

Any of the above steps begin to shape the behavior toward initiative and independence because they take into consideration physical, cognitive sensory and language strengths or weaknesses. Rewarding the child with positive reinforcement for each step they are able to master encourages repetition of the action and more unprompted, spontaneous behavior.

The Role of Language Acquisition

Have you ever noticed how talking affects your behavior?  Think about a time when you found yourself taking action after telling someone how you felt about a situation.  For example, sometimes after we express hurt, we may decide to leave a situation or ask a person for an apology.  These independent, assertive actions are motivated by the words we express, as if those words were a map showing us what to do in certain circumstances.  When we use words to clarify what we want or feel, we feel more empowered to take action.  In that sense language is “self-prompting” in that it serves as a catalyst for independent action.  We are driven to take initiative as a way of getting understood or having our needs met.

Goal plans developed for children with autism must include speech goals that teach assertive language as well as “self talk”.  The ability to turn words into communication to ourselves also strengthens our ability to figure out what to do, or what to say further to others. Self talk becomes the precursor to expressive language and speech therapists should include “self directing and self reflective” self-talk goals in the treatment plan.  For example, when a child wants to ask another child to share something with them, that child would be more inclined to ask if they had thoughts such as:

• “Johnny is a nice boy.”
• “I will ask in a nice way.”
• “I will offer to share something with him.”
• “I will promise not to break it.”

These self-assertions lessen anxiety, which in turn promotes less resistance to taking a verbal or physical action.  For a child in the same situation with more limited cognitive and language abilities, the steps towards developing more independent communication and behavior might include:

• Pointing to the desired item and saying, “please’;
• Having an adult verbally or physically model the request;
• Teaching the child to say “Let’s share”;
• Enjoying the desired item in joint play and saying “Thank you.”
• Writing the request on paper or having the child write the request

The more words or other forms of communication a child has the ability to use, the easier it will be for them to take the initiative towards getting what they want or need.  Once that child begins to see that their words, signs or writings have an effect on getting what they want or need, he or she will become more motivated to use language for communication with others, and as a result will become more behaviorally assertive.

The Role of Social Functioning

When we are part of a group, we become motivated to act in ways that will gain the attention and acceptance of others in the group.  Children with mild deficits will tend to take more initiative independently because they will be more aware of his/her own feelings and social needs, such as being liked and accepted.  A child with some social intelligence will figure out that certain actions make people laugh or happy, and therefore, will be more likely to repeat those actions on his/her own in order to promote those responses from others.  To encourage additional independent social behavior, these children should be helped to expand on their repertoire of social behavior and communication to develop more interesting and deeper connections to peers.

Children functioning at a lower level of cognitive and social awareness require additional supports to increase independence in social situations.  Many of the social behaviors need to be modeled and paired with explanations appropriate to the child’s level of understanding.  For example, when you model saying “hello” for a child and pair it with a wave of the hand, you also explain to them that it is a friendly thing to do, and it makes people feel good and notice them.  Pairing the action with the explanation increase the odds of a child adopting the behavior because taking action with their body and using language can increase the level of intention and involvement in the action.. This approach has been shown to awaken responsiveness in many children with autism, especially those who are having low affect or are hypotonic”.

In order to promote interactions in group settings, it is helpful to set up scenarios where children depend on each other for completion of a task.  For example, if one child has an item that another child needs to complete a task, there is an increased chance the one child will offer the item to the other, or the other child will request the item.  Social settings are opportunities to promote independence because children can be taught they can help the group or complete the group in some meaningful way, simply because of an action they take.

The Role of Cognitive Development

One way in which cognitive functioning is measured is by the level of behavioral and emotional understanding shown in a situation.  When a child understands the concept of what is happening, and understands his or her own feelings and the feelings of others, that child is more apt to take constructive, meaningful action.  Without this clarity and accuracy of thought, children often shy away from taking the risks which go along with taking action.  Autistic children with significant cognitive deficits 1) often lack the ability to know how to figure out what to do in a situation (problem solving deficits), 2) cannot project and anticipate what might happen next, 3) have difficulty developing alternate plans of action, and  4) have problems understanding their own feelings and the feelings of others.

The lack of independent action is directly related to not understanding a given situation, and what is expected of him or her in that situation.  For example, if a child is accustomed to their teacher starting out the day by saying, “Let’s get your materials out of your desks,” he or she might be confused if a substitute teacher starts out the morning by saying, “Let’s get started.”  That confusion will lead to inaction because it is not clear what is being asked of them to do.  Using visual supports, gestures, and pairing words with actions are tools which are often necessary for a child to really understand what he or she is supposed to do.

All programs aimed at developing cognition should include strategies that teach 1) how to use the child’s processing strengths to increase general comprehension and social intelligence, 2) problem solving skills to apply when something does not work out as planned, and 3) social learning skills that build confidence and competence in social settings.  When a child is taught a process for developing thoughts about what is happening in his or her environment, they become more able to figure out appropriate actions to take.  Therefore, with more clarity and confidence, he or she becomes more independent. Examples of strategies which help develop such cognitive growth by challenging rote, rigid thinking are:

• disrupting a pattern in the child’s life so that he or she is required to think about what to do differently;
• hiding needed items in strange and new places;
• making a familiar sequence of behaviors  more complicated; and
• creating opportunities for all of these strategies to occur in new situations, in different places, and with different people.

Once autistic children learn that they have to think differently across multiple circumstances, cognitive growth is promoted.

Independent, initiating behavior is possible for children with autism.  However, to achieve that goal it is necessary to build interventions with an understanding of the individual child’s deficits and strengths in the major domains of language, social and cognitive functioning.   Autism programs should emphasize building cognitive skills with well-defined strategies which encourage and support social learning and independent behavior.  To do that requires patience, creativity, knowledge and flexibility by all who work with and live with these special children.

© Rebecca Sperber, MFT

Pink for girls.  Blue for boys.

While I think the majority of parents have begun to break away from that tendency, it still seems to be the basis for design in the majority of children’s rooms. There is nothing inherently wrong with utilizing these colors at all, it has more to do with the shades of these colors and how they’re used with regard to a special needs or autistic child. Once again, the way the neuro-typical child responds to these average primary and/or bright colors is vastly different then the way a special needs/autistic child might respond. Certainly using softer versions of these colors are fine, but again, it’s important to look into the way they’re used and how much they’re used.

Color on the ceiling. Should you or shouldn’t you… and what color? Do you paint a sky motif with clouds, a space motif with space ships and stars, do you paint it a solid color and if so, should it be darker or lighter then the wall colors you use? Should you hang educational mobiles depending on your child’s age or cognitive needs?

The list of queries could go on indefinitely and frankly, tend to vary quite a bit from child to child. This is why it’s helpful to learn about other parents experiences, but not count on their outcomes to be the same for you or your child regardless what similarities there might be. Physically, the child’s responses will almost always be unique and will manifest in each child differently.

A general rule with regard to any design on a ceiling is to consider the size of the entire room. Darker colors tend to make the room feel smaller and light colors open it up and allow for a more spacious feel. This is a good guideline when contemplating your design motif.

As parents you may also know how clutter can exacerbate a child’s sense of turmoil and chaos. (after all it tends to do that to all of us!) but it’s effects are much more visceral for the special needs/autistic child. Therefore, when deciding on the way to store your child’s books, toys, games etc… try to avoid the average pitfall. That is the tendency to get big clear plastic bins. It might seem like the perfect solution due to the fact that you can see what’s being stored therefore it’s easy to discern where a particular favorite item might be. However, all of the different colors, shapes; and objects combine to create an overload of visual stimulation.

Instead, look for storage units that combine shelves with doors. That way everything can be put away but remain out of sight. The overload of visual stimulus is averted and you can select what you want to remain in sight and what should be stored away until the appropriate time it is to be used.

Look at the layout of your child’s room. Is it very small or somewhat large and empty? Resist the temptation to utilize all the furniture you originally envisioned as it simply may not be conducive to the space. If you don’t consider the room you have and just focus on the furniture, you might inadvertently close off whatever open area you do have or, conversely, overstuff the room with extra items or over sized furniture in an attempt to keep the room from feeling too sparse. In the end you don’t accomplish function or form within the room.

In short, simply take some time to shift the way you think about décor and focus on the goals for your child’s personal progress within their space. Utilizing these principles as a guide should make creating the perfect space for YOUR child a much easier and more enjoyable endeavor!

Pat Mirenda, Language, Speech, and Hearing

Services in Schools, Vol. 34, No. 3, July, 2003

That quote alone should render unnecessary even one article—let alone two—devoted to singing the praises of manual sign use for people with ASD!  Specifically, what more needs to be said to “sell” readers on the benefits of using manual signs beyond the research-based assertion that their use promotes faster and better vocabulary acquisition than speech alone?  As it turns out, a lot more needs to be said on the subject of manual signs, since getting people to actually use them in the education and treatment of those with ASD is a genuine “hard sell”.   Indeed, one might say that sign language suffers from the Rodney Dangerfield syndrome, because in the phrase made so memorable by that comedian, it gets no respect as an intervention tool for those with ASD!  This article explores the “whats,” the “hows,” and the “whys” of this remarkably simple and yet highly effective intervention tool.  Furthermore, it specifically addresses the use of manual signs by adults as a means of enhancing their verbal messages, rather than the practice of actually teaching manual signs to children with ASD.

What is Sign Language?

While there are many different varieties of sign language, they all have one thing in common—they provide a visually-based way of communicating.  Since I am most familiar with American Sign Language (ASL), it will serve as the vehicle for manual sign use set forth in this article; however, the information presented is applicable to the different types of sign language used in other countries / cultures.

The first thing that must be said about sign language is that it is a natural language in the sense that it can be absorbed from birth, and used to express a wide variety of diverse communicative functions and needs.  In fact, ASL has been recognized by linguists as an authentic language, since it contains the essential elements that all natural languages contain.  In recognition of the legitimacy of sign language as a bona fide communication system, more and more schools across the United States of America are adding ASL to their foreign language offerings.  This would seem to be most appropriate, since according to Daniels (2001) “nearly 15 million people in North America [are] able to communicate to some degree in sign language, making it the third most commonly used language in the country”  (p. 16).

How Can Manual Signs Be Used with Individuals with ASD?

Using sign language to highlight certain words and phrases, has been found to be a highly effective way of enhancing communication and language for all students, particularly those with special needs.  The advantage here is that using manual signs in this manner is eminently user-friendly and flexible—easily learned and readily employed in educational / treatment programs, regardless of philosophy.  Indeed, all that the interventionist needs is a sign language dictionary, a little practice, and a commitment to stick with it.

The following example serves to illustrate just how easy it is to incorporate manual signs into educational / treatment programs that serve students with ASD.  The bold-face type indicates the words that could be signed as they are spoken.  While there is some flexibility, the general rule of thumb is to sign those words that you would want to highlight:

Susie, please come here.  Thank you.  It’s time to do some work.

First we will work, and then we will play.  I’m going to show you three things.       Two will be the same, and one will be different.  Good job!

Before moving on to the next section, it is important to note that a key component of using manual signs in educational programming is that of consistency. Having said that, one of the most frequently observed “bad practices” is the haphazard use of manual signs.  To be of benefit to the student they need to be used consistently across people, activities, and environments—and that most definitely includes teaching parents to use manual signs at home.

Why Use Manual Signs if the Child Can Hear?

The simple answer to this question is that there is a great deal of research that clearly demonstrates the benefits of using manual signs to enhance communication and language in hearing students with special needs.  Expanding on Dr. Mirenda’s above-noted statement regarding the positive effects on language of using manual signs, Daniels (2001) states,

Historically, sign language has proved useful for language-delayed,

language-disordered, and learning-disabled populations.  Typically,

specific signs have served as gestural cues for children with

communicative impairments, for children with Down syndrome, for

children with aphasia, and for children with autism.  Using sign

language as a communicative tool with educationally challenged

hearing children improves their communicative competence and

academic ability (p. 93).  

Daniels (2001), speaking specifically about children with autism, goes on to state that manual signs can be used to “make it easier for children to follow directions, as a way to help children make connections between words and concepts, and ultimately as a method for leading them to speak” (p. 97).

Part two of this article will take an in-depth, “goodness of the fit” look at the specific ways in which the use of manual signs serves the multifaceted needs of individuals with ASD.  It will also examine the widely held myths and erroneous judgments that have prevented sign language from garnering the respect it deserves as a highly effective intervention technique for this population.

References

Daniels, M. (2001).  Dancing with words:  Signing for hearing children’s literacy.

Westport, CT:  Bergin & Garvey.

Mirenda, P. (2003).  Toward functional augmentative and alternative communication for students with autism:  Manual signs, graphic symbols, and voice output communication aids.  Language, Speech, and Hearing Services in Schools, 34, 203-216.

© Diane Twachtman-Cullen, Ph.D., CCC-SLP

Myth #3:  Using pictures or other visual symbols with nonverbal children will cause them to become dependent upon these types of supports.

Not all myths are created equal, and this one is among the most damaging, particularly since individuals on the autism spectrum, with rare exception, have greater strengths in the visual, as opposed to the auditory realm.  For one thing, this myth flies in the face of research.  For another, it insulates the child from receiving valuable and much needed visual support.  Simply stated, there is ample research evidence that demonstrates that the use of pictures and manual signs not only support, but actually facilitate the development of verbal language in many children with and without autism. If that isn’t reason enough to use these supports (and it surely should be!), visual supports can also help to facilitate word retrieval, reduce frustration, and most importantly, provide a means of augmentative communication for the child who is either nonverbal or minimally verbal.

Myth #4:  The best way to increase length of utterance is to insist that the child always says the whole sentence.

I call this one, “the full-sentence press,” because I find insistence on saying the full sentence to be overbearing (and often overwhelming!) for those students with autism who are struggling to retrieve words, formulate thoughts, construct messages, and deliver them to intended listeners.  In my opinion, the mantra, “Tell me in a complete sentence,” quite literally glorifies form (manner) over substance (message).  It also adds additional stress to speaking situations—not a good thing for individuals who typically experience high levels of anxiety.   This is not to say that increased length of utterance is not a desirable goal.  Surely it is.  But there are ways to increase phrase and sentence length that are far more natural, less stressful, and more effective.  For example, manual signs could be used to unobtrusively prompt additional language.  This practice can be applied independently, or in concert with the “playing dumb” phenomenon in which the adult pretends that s/he doesn’t understand something so that the child has to use additional words to elaborate the message.

Myth #5:  The most effective way to teach language is to use flash cards.

Second only in the damage department to myth #3, this myth assumes that labeling a picture can somehow convey its meaning and also ensure appropriate use of the word in the real-world environment.  But saying a word; knowing what it means; and using that word in the appropriate context are all different parameters that involve different types of competencies.  For example, being able to say apple in response to a picture does not automatically enable the child to request an apple when s/he is hungry.  The reason for this is that saying a word involves the physical act of moving the articulators (i.e., speech); understanding what the word means involves semantics (i.e., meaning); and being able to use the word appropriately—for example, to request—involves pragmatics—the social use of language in a particular context.  Since pragmatic communication difficulty is the quintessential element of language impairment in autism, and because it is complex and multidimensional, language use should never be assumed based upon the learning of word labels. Moreover, addressing pragmatic communication impairment requires a context for word use—an element conspicuously lacking in therapy-by-flash-cards.   While flash cards may be useful for language games and additional vocabulary practice, to say that they are the most effective means by which to teach language is a myth, and a seriously misleading one at that!

Coming Full Circle

Ironically, it is likely that the deceptive ease with which verbal language develops in neurotypical people serves to blind us to the underlying complexities inherent in the language-learning process—a shortcoming that can easily lead to the promotion of myths that mitigate against best practices in language development.  Hopefully, the myths discussed within this article and the previous one will give much needed pause to those who fail to understand and appreciate the exquisite complexity of the language learning process.

© Diane Twachtman-Cullen, Ph.D., CCC-SLP

Myth #1: Talking must be easy since so many people do it so effortlessly.

Nothing could be further from the truth. In fact, the act of speaking – and all that it involves – is arguably the most complex task that human beings are called upon to learn. For example, to utter a simple one-syllable word such as church is a motor planning extravaganza, requiring well over twenty precise, exquisitely timed movements, all occurring in a particular sequence. Imagine the motor planning that goes into extended discourse!

The act of speaking, of course, involves more than moving one’s articulators (e.g., tongue, lips, jaws, etc.). It also involves the selection of specific vocabulary to accurately convey one’s message. Given that many words have multiple meanings, and that different words can mean the same thing, this process is anything but straightforward. Talking also involves social decision-making (i.e., pragmatics), such as knowing what, how, and when to say something, and who to say it to. In addition, since communication is a two-way street, talking also involves keeping track of what another speaker says, and what he or she knows, so that an appropriate, on-topic response may be formulated. Problems here run high in ASD. While this explanation barely scratches the surface of the complex multifaceted skill of talking, it should at least convince the reader that the act of speaking is anything but simple.

Myth #2: He only says a few words, but he understands everything.

There are several reasons why individuals with autism may appear to understand “everything.” The most likely cause, however, is probably attributed to their excellent rote memories, and their ability to follow routines with ease once they learn them. For example, of the child’s typical routine upon arriving home from school is to hang up his jacket, wash his hands, get a glass of milk from the refrigerator, and sit down at the table for a snack, his parents might assume that it is their directional cues that prompt the child’s responses. In actuality there are many cases in which individuals with autism are responding to the customary routine, rather than the verbal prompts to hang up jacket, get a glass of milk, and so forth. A simple way to determine the child’s level of understanding of verbal directives is to either vary the routine (i.e., give directions that are out of the customary order), or direct the child to do something novel. If, under such circumstances the child continues to do what he’s always done, it is likely due to his not understanding everything. And, if you find that to be the case, then it’s a good place to begin building in comprehension.

More speech-language pathology myths to come in the next installment of Autism at Home Series, so please “stay tuned”.

For parents, the greatest fear about a period of regression in behavior and other functioning is that the regression will be permanent and or that it is a sign of a poorer prognosis than previously thought.  Doubt, guilt and fear can overcome parents and an all encompassing negative outlook can become more detrimental to the recovery of the child than the regressive episode itself.  Being educated about what might be causing the regression is helpful both in treating the presenting problems.  Awareness of what might be causing the problem will help the treatment process, and also help parents and professionals deal with the emotional strain of the experience.

My personal story provides the framework for this article and can be used as a template for navigating through regressive episodes and coming to terms with what to do when they happen.  Learning how to manage the feelings that emerge through the experience and develop an understanding of what the regression is “communicating” about the child’s condition are major goals in the process.

The “Episode”:  April 2006

I had decided take my son to see a new psychiatrist.  He had not had an evaluation by a psychiatrist in years, and my specific goal was to discuss the issues of apathy and the lack of self initiating behaviors.

I felt that these issues were holding Benny back in the in the areas of cognitive, social and language development so I was open to the doctor’s suggestion of medication.  Celexa, which is an SSRI (serotonin reuptake inhibitor) medication was prescribed in a low dose on a once a day basis.  After one dose of the medication, my son had a drastic gastrointestinal reaction (severe diarrhea) which lasted almost 10 days.  Ten days after the intestinal symptoms stopped, his regressive patterns of behavior began.  The simplest way to describe what he was like is that he just stopped doing what he had been capable of doing before, even down to being able to comply with the simplest requests such as “Benny, come here.”  We found ourselves using words like “frozen”, “stalling”, and “sticking” to describe his behavior.  He would start to get out of a car, then freeze with one leg hanging out.  We would ask him to hand us something he was holding, and he would stare at us as if he did not know what we were saying or what he was supposed to do.  Then the behaviors began to vary, from not even trying to move or comply, to starting the action and stopping midway into it.  He became unable/unwilling (depending on the perception of the person trying to deal with him) to make simple transitions Sometimes it would take almost an hour to leave a restaurant, store or car.  Eating a meal or getting dressed became a drawn out process, most of the time having to result in maximum support to complete the activities.

Benny also lost a significant amount of his already limited verbal communication.  Requests for language were met with the same silent, frozen responses as with requests for physical compliance.  Life became extremely stressful and painful for us, and seemingly frustrating and scary for Benny.  By late April, we began the process of talking to a variety of professionals to get their perceptions and diagnosis of what might be causing the regressive functioning.

The Behavioral Perspective

The behaviorists used words such as non-compliant, oppositional and defiant to describe Benny’s behavior.  The speculation was that Benny might be testing the limits being place on him and trying to assert his personal control.  I was encouraged by this thinking, in that I knew that if this was the reason behind his regressive behavior, it could be an indication of an increase in executive function (cognitive development) or emotional or relational intelligence.  The behaviorists were clear with Benny about what behavior was expected of him and used positive reinforcements when he was able to do the behaviors.  Unfortunately the behavioral strategies applied did not work.  Benny did not seem to be motivated by positive reinforcements and he continued to physically “freeze up” or physically resist any kind of physical attempt (modeling behavior, hand over hand, etc.) to get him to comply.

Other therapists and teachers working with Benny felt the regressive functioning was volitional, that he could control it, but was choosing not to.  The presence of certain behaviors, (such as Benny’s ability to reference to a person through good eye contact or indications that he receptively understood what he was being told but refused to do it) encouraged their thinking along these lines.  There were times in the beginning of this regressive episode that I felt that this assessment might be correct.  But I had my doubts and thought of ways to test the hypothesis of “intentional opposition”.  I began to give Benny alternatives to requests being made of him.   For example, instead of telling him to come when it was time to eat, I would sit down myself, start to eat and make sounds about how good the food was.  I knew he was hungry, and I would put his food far enough away so he would have to come to eat it.  I removed the verbal command for him to resist   and he would still not come and eat.  It was as if he was unable to execute what he needed to do with his body in order to complete a sequence, even if was about a preferred situation “he” could choose.  If I brought the food over to him, (which is a less demanding way to signal him to go into action), he would still just stand there.  But when I tapped his hand to move it (sensory input to cue awareness to his hand), or pointed to the food and made the sign to “eat”, he would eat.  This told me that with extra communication to his body about what it was supposed to do, he could “unfreeze.”  When completely left to his own devices, he could stay stuck indefinitely, as if he was unable to function without us.  If his behavior was all about control and defiance, even the milder forms of prompting and instruction would have been resisted by him.  Oppositional/defiant kids often do the opposite or choose something other than what is requested in order to assert their independence or to rebel.  This did not describe our frozen little boy.

There were times when the sensory input did not work, and we had to come up with other strategies.  All the techniques worked for a short period of time, and then they would lose their efficacy.  I believe this meant that for some reason, the “novelty” aspect of a strategy would jolt his attention and his awareness and cognition would be heightened, but when any approach became too familiar or predictable by him, he froze up again, almost as if a mind/body separation would occur.  Some of the strategies that were effective for a time were:

• Putting commands on cue cards that he could read out loud. ) When he read them, he would do the action, which reminded me of the powerful influence that language had over the ability to act independently, or spontaneously.)
• Reverse Psychology (For a time, if we said “OK, then don’t sit” he would sit.
• Telling him our feelings about what he was doing (We would say, “I am getting upset because you won’t get in the car.”
• Putting a preferred item in the path of where we wanted him to go. The motivation for the object would sometimes “pull” him into motion.
• Having different people intervene in facilitating him
• Giving him pictures of what we wanted him to do or where we wanted him to go
• Giving him a lot of time to process what we were asking of him
• Simplified language with the focus on his name and the action
• Giving him alternative choices to make
• Changing plans and changing some aspect of the requested or the style of communication (changing voice volume or singing the language).

Most of these strategies worked intermittently and we were encouraged.  We felt there was hope that we were still able to get into his world.  But the “freezing” kept coming back.  We knew we had to learn more about the responses he was having and we decided to consult professionals from a variety of different areas of psychological and medical schools of thought.  We contacted people who had worked with Benny over the years so we could compare their different mindsets about the regression and hopefully learn more about the cause and treatment.

The Neurological Perspective

I brought my son to see the neurologist within two weeks from the start of the symptoms.  At that time, Benny was not responding to requests or commands, was making rigid movements with his arms, and having facial movements that seemed involuntary.  The doctor observed Benny and talked to us about what could have happened to cause this.  There were no recent traumas or changes in Benny’s life or to anyone in the family.  The doctor said Benny did not seem depressed or anxious and the movements, posturing and freezing behaviors seemed to be involuntary.  The preliminary diagnosis was a possible allergic reaction to the medication, Celexa, as that was the only recent change to any of Benny’s treatment.  He told us he would contact the manufacturer of the medication to see if there had been other reports of such a reaction in children Benny’s age.  In the meantime, he assured us that the symptoms would diminish over time and that there was no medication or procedure to help with this process.  He did not believe that Benny was having seizures and did not recommend an EEG or any type of brain scan.  He said the symptoms Benny was having was similar to a condition Parkinson’s patients have called Tardic Dyskinisia, where the body is unable to complete or initiate movement at certain times.

The Psychiatric Perspective

Several weeks later, Benny was in the same pattern of symptoms and daily life was difficult for him and our family.  I took him back to see the psychiatrist who had prescribed the Celexa.

I told him what the neurologist’s opinion was and he did not agree with it.  He said he believed it was possible that the stress of the side effect of almost two weeks of severe diarrhea may have caused Benny extreme anxiety and this could be impairing his ability to move about comfortably and securely.  The doctor was unsuccessful in his attempt to get Benny to interact with him or to comply with requests during the consultation.     He persisted in his original diagnosis of Anxiety Disorder and made several, non-medication suggestions, such as occupational therapy, physical therapy and acupuncture.  He had also mentioned a medication to increase Dopamine levels, as he said the inhibition of physical movement could be a sign of a deficiency in Dopamine.  We chose not to pursue medication therapy at this time due to Benny’s tendency towards severe side effects.

The Developmental Perspective

I next turned to our developmental psychologist, Dr. Arnold Miller, a renowned autism specialist, director of the Language and Cognitive Development Center in Boston, Massachusetts, and author of two books, From Ritual to Repertoire and the recently published, The Miller Method. Developing Capacities of Children on the Autism Spectrum.  Over the past 5 years I have been trained by Dr. Miller, via video conferencing, in his method, the Miller Method, which is a cognitive,

developmental systems approach to treating autism.  Dr. Miller has also provided direct treatment to Benny through video conference training in our home.  His observation of Benny’s regressive behaviors yielded a different theory than the other professionals.  He believed that Benny was experiencing severe dysfunction in the area of body awareness and body organization.   This is an area of expertise for Dr. Miller, whose method for treating autism involves facilitating body awareness, body organization and language through the use of functional systems (i.e. pouring water, stacking dishes) that teach children they can have an effect on their environment by initiating action upon aspects of a system involving objects and people.  When we asked him why Benny not pick up his fork to eat on his own anymore or why he would not get out of the car when the door was opened, Dr. Miller said that it seemed that Benny had lost the ability to be automatic and independent in the use of his body and was no longer able to tell his body what to do.  Dr. Miller said his dependency on prompting indicated he needed to use other people as an extension of himself.

In other words, he had currently lost a part of himself.  This described Benny’s functioning when he was 6 and first began treatment with Dr. Miller.   This theory explained why Benny now required maximum prompts to physically and verbally react to requests being made of him.   He had truly regressed back to where he was 5 years prior.

Dr. Miller helped us devise ways to assist Benny in re-learning what he was supposed to do with his body in different situations.  Some of these strategies were:

• Using flash cards to tell him what to do with his legs when we wanted him to walk ( i.e. “pick up leg”)
• Showing him pictures of himself engaged in resisted activities
• Tapping each individual body part as a signal for him to “feel it” so he would know to use it
• Applying pressure to his joints
• Engaging in big body activity
• Modeling with our body what we wanted his body to do
• Giving an object that is needed to complete a “system” (i.e. a piece of a puzzle, the last block on a block tower, to “urge” his body to move…)

• Counting  to 5 or 10 and saying “go”

As the weeks passed, Benny’s symptoms lessened.  He responded to the strategies and we were able to resume regular activities with more success.  But the symptoms did not disappear, and eventually another regression of behavior occurred and the prompts stopped facilitating compliance.  Benny became agitated to what had become predictable attempts on our part to get him to comply with requests to talk, transition, and perform simple home and school tasks. It was as if he could not bear the demands of every day functioning and he wanted to be left alone to do very little.

Dr. Miller said that this alienation from his body could be a result of the onset of puberty, with his body beginning to feel differently, he may have lost his ability to relate to it and use it the way had had become accustomed to.  He said many kids regress during the years of puberty, experiencing mood changes, body awareness issues, and sensations that confuse and distract them.

Moving into Solution, Acceptance and Cause vs. Cure

After several months of dealing with Benny’s regression issues, we became used to having to apply the many rituals necessary to get him “unstuck”.  We developed curiosity and creativity in helping him to be able to function.  Our repertoire had grown into a system of ideas and interventions that took into consideration some of the expert evaluations of Benny’s condition and our own intuition and knowledge that grew out of living with him for years.  Despite the regression, he was still Benny, a lovable, emotional and complex little boy.  He was able to walk, talk in 1-4 word sentences, ride his back, play simple board games, watch his favorite videos, resume his schoolwork, go to stores and movies, and hug and cuddle as he had done before.

We also realized the importance of establishing relationships with professionals that we could trust to listen, (to our emotions and instincts, as well as the details of Benny’s behaviors), and be available, curious and persistent in helping us find solutions for the regression and ideas about recovery from it.

Part of the solution now included a heavy dose of positive thinking.  Our strategies did help at times, and we knew it meant that Benny needed us to be strong, smart and persistent in helping him.  We also developed a healthy sense of competition between ourselves, (whose approach would work today?) and often shared some good smiles and laughs about this journey through regression to recovery.  The process was difficult, but in hindsight it forced us to pay more attention to the varied ways our son communicated what he was going through by being autistic and experiencing life through a complex and mysterious filter.  But the work has yielded much knowledge and effective tools to cope with whatever curve balls autism throws in Benny’s path.  We hope that through this experience, Benny somehow knows that no matter what those challenges will be, his family is up for the challenge and that regressions are now a part of moving forward.