Autism Spectrum Disorder: Supporting Children and Youth – Module 2

Setting the Stage for Learning

Introduction

Creating a successful learning environment for children with ASD may require adaptations in the following areas: physical environment, visual supports, transition strategies, schedule and routines.

Children with ASD in Group Child Care Settings

An inclusive philosophy is reflective of society’s view that all children have the right to equitable opportunities in education. While there is much variation with respect to strengths, abilities, functional levels and challenges among children, preconceptions should not be a barrier to inclusion as all children benefit from being a member of a diverse group. Inclusive settings can be beneficial for all children in the classroom.

Benefits of Inclusive Settings

Chances to learn by interacting with other children of similar ages
Time and support to build relationships with other children
Chances to practise social skills in real-world situations
Exposure to a wider variety of challenging activities
Opportunities to learn at his/her own pace in a supportive environment
Chances to build relationships with caring adults other than parents
Opportunities to build friendships

Benefits of inclusive programs for typically developing children include:

Increased appreciation and acceptance of individual differences
Increased empathy for others
Preparation for adult life in an inclusive society
Opportunities to master activities by practising and teaching others
Opportunities to build friendships

Considerations in Group Settings

Physical Environment:

Children with ASD benefit from stability and predictability within their environment. When changing or moving furniture, keep in mind that some children may need help and time to adjust to change. Changes can be made but may need to happen gradually.

Space

To reduce running and wandering behaviours, provide smaller, more contained spaces.
To assist children with identifying and focusing on what to do in a specific space, provide spaces that are distinct from each other for different types of play.
To help define spaces, use shelves, furniture, and on a carpeted area, further define by placing individual mats. Create a calming corner using portable furniture for children to have quiet time.

Reduce the amount of visually-distracting materials by keeping the classroom clutter-free.
Keep artwork in one spot such as a bulletin board outside of the classroom rather than scattered throughout the room.
Look for opportunities to provide natural lighting and subdued wall colours.
Add sound-absorbing materials such as plush furniture and carpeting (where permitted).
Have play areas that are set up for individual play, pairs, small group play, and large group play.

Materials

Use appropriate seating which may consist of traditional chairs and tables, or more supportive seating such as a Raylax chair or Howdahug chair that promotes focus during individual or group times. Traditional chairs should allow the child to sit with good posture, have feet flat on the floor, and hips, knees and ankles at 90 degrees. Tables should allow the child to sit with elbows about 1-2” below the table top. In some cases, a chair with arms may provide additional security and boundaries for a child to help with sitting and attending.
Promote relaxation, security, and ways to self-regulate. For example, beanbag chairs, large overstuffed pillows and child-sized rocking chairs may be placed in some spaces. A small tent with pillows inside and heavy quilts on top may offer an opportunity for brief respite from noise or others’ activity. Sensory materials such as rice bins, playdough, and tactile boards can be calming for some children.
Provide for physical activity using heavy objects to lift, carry, or push. Schedule use of these materials regularly and between activities that require focused attention as a way to regulate emotions and prevent disruptive behaviours before they happen..

Visual Supports

Adults rely on visual helpers every day such as calendars, day timers, street signs, grocery lists, maps, and so on. Visual cues in the environment allow planning, organizing, and independence. Visuals are equally important to children because they are just beginning to learn how things work in the world.

Why do visual supports make it easier for children to understand and communicate?

Words “disappear” right after we say them but visuals hold time and space.
Visuals direct attention and hold attention.
Visuals allow more time to process the information.
Visuals assist in remembering.
Using the same words every time a visual is shown teaches the child those words.

Anything we see that helps us with communication by giving us information for our eyes is a visual support. The type of visual that works best with each individual child depends on what is meaningful to the child. The most widely-recommended visuals are those that are used to provide children with information.

For example, labels placed around the home or classroom help to inform the child where to find and where to put materials. Rules provide your child with clear expectations. Other types of visuals that give information in a logical, structured and sequential form consist of schedules, mini-schedules, and “first/then” boards. Activity choice boards allow the child to make selections during their play.

photo of schedule with boardmaker pics of breakfast, school, home, swimming, dinner, bedtime

The previously named visuals can be presented in several formats, depending on the child’s level of understanding. Ranging from most concrete to most abstract, possible visuals are:

Objects – would be considered to be the first level of visual representations and would include the actual objects (e.g., for some children, seeing a sandwich in their parent’s/teacher’s hand tells them “It’s time for lunch.”)
Colour photographs – would consist of coloured photographs of concrete objects (e.g., for some children being shown a photograph of a bus means “We’re going to daycare” or “We’re going home.”)
lack and white photographs – would consist of the same photographs but in black and white
Colour line drawings – picture symbols that are often used with children who are able to understand at this level of abstraction
Black and white line drawings – also picture symbols and serve the same purpose as coloured line drawings
Miniature objects – smaller versions of the objects

Tip: Remember to place visuals at the child’s eye level.

Preparing for Transitions

For many children, routines and structure are important because they provide a sense of security. Even slight changes in the usual routine can be highly upsetting. Preparing for transitions and having consistent routines help children to cope with change.

Children may have difficulty making transitions for many reasons. Here are some examples:

Change is unexpected For example, weather prevents children from going out for regularly scheduled outdoor play.
Current activity is enjoyable For example, child does not want to stop present activity for another event.
Dislike or fear of the next activity For example, child knows what the next activity is and does not like it or is afraid of it, so resists getting ready.
Next activity is enjoyable For example, child leaves present activity early in attempt to start enjoyable activity before it is time.

There are two main types of transitions:

Daily: Major transitions during the day for young children usually involve sleep, mealtimes, or changes in the environment/location such as:
- From one activity to another
- Indoor to outdoor play
- School to home
Life These are transitions that occur once in a while (e.g., starting a new job, having a baby, or moving). Children need extra care and attention during these times because change can be upsetting and frightening to them. For example, at daycare a child may be moving into another classroom with a new teacher and new children or a child may be moving to a different house.

Strategies to help a child make transitions:

Provide verbal warnings

Use warnings that a transition is about to occur. For example, “It is almost time for lunch.” The transition can be made concrete by setting a timer or counting down from ten after giving the warning.

Fidget Toys

If a child is finished with an activity but needs to wait for another one to begin, playing with a fidget toy (e.g., squishy ball) can help him/her keep busy. Experiment with a variety of fidget toys and choose ones that do not make noise and that the child is able to keep in his/her hands or pocket.

Transition Objects

Try using an object to signal that a new activity is about to begin. For example, if the child is playing and it is almost outdoor play time, bring the jackets into the room within sight.

Music

Songs are a fun way to signal that the current activity is about to end and a new one will be beginning. They help children learn routines and improve language and memory skills. Try using the same tune and changing the words for different activities. This will make it easier for children to remember the song and join in the singing. Learn more about transition songs by visiting the Creative Circle Time: Music, Stories and Games Workshop.

Visual Cue

To gain children’s attention, turn the lights off and on or say, “Put your hands on your head.” Once you have the children’s attention, begin the transition by singing, “It’s time to tidy up. Tidy up. It’s time to tidy up!” The song could be followed by two handclaps before turning the lights back on and then the children start to tidy up. This combination of strategies works because gestures and songs catch children’s attention.

Visual Schedule

Using objects, photos, or pictures to show a child the order of activities that are planned can help him/her understand what is going to happen next. Here is an example of a visual activity schedule.

Create visual schedules using photographs, pictures from magazines, or the Visuals Engine on this site. When first using a visual schedule, include one or two transitions. Gradually add more, up to a maximum of six or seven pictures in one schedule, based on the child’s developmental level.

To help a child understand when an activity is finished, attach pictures to a piece of bristol board using tape or velcro. As each activity is finished, a child can remove it from the schedule and put it in a small box or envelope labeled “finished”.

For some children you may want to have a full visual schedule of the day on the wall for reference. For transitions you might want to have a separate one that shows what is ending and what is starting. For example, “First tidy up then go outside”. Using a “first/then” visual to break down the immediate expectation can help the child understand what is coming next. This can also help the child to focus on the transition and what he/she needs to do.

Schedule and Routine

Schedules, predictability, and routine are essential for a child with ASD to function well, particularly in a group setting. Keep in mind the following:

Provide consistent and frequent use of visual schedules of the daily routines and activities.
Maintain a routine that does not vary much from day to day, especially when a child is new to the program.
Ensure that the location of materials and equipment is consistent.
Maintain an initial consistency in the staff the child will encounter daily to help establish routine.
As the child becomes more comfortable, introduce small changes gradually to help him/her develop some flexibility. Examples could be changes in routine, place, and staff, using visual supports and schedules to cue the changes to the child.
Provide a written individual schedule for the child with ASD, showing what s/he will be doing and with whom. Post this where it can easily be seen by staff to maintain consistency and structure for the child.
Provide consistency for staff as well. Provide a written schedule of who will be where, doing what.
Schedule routine time for staff to plan and communicate about the needs of a child with ASD, with parents and consultants as needed or available (see Module 8).

Next Module: Observing and Understanding Behaviour

Autism Spectrum Disorder: Supporting Children and Youth – Module 6

Developing Functional Play and Adaptive Behaviour

Introduction

Children with Autism Spectrum Disorder often have challenges with functional play skills and adaptive behaviour (tasks associated with daily living). They benefit from environmental supports and direct instruction to develop their play skills and independent living skills. There are strategies and supports that incorporate direct teaching of play and other adaptive skills to develop essential skills. See Modules 3 and 4.

Developing Functional Play

1. Definition and Importance of Functional Play

Functional play can be defined as play with toys or objects according to their intended function (e.g., rolling a ball, pushing a car on the floor, pretend feeding a doll).

Play is a way children learn to make sense of the world. Functional play is a powerful tool for developing cognitive and social skills. Play develops a child’s problem-solving skills through the discovery of properties of actions and objects (e.g., hard/soft, fast/slow, and how things work together).

Functional play is also important in social interactions. Children interact with each other through play with toys, equipment, and action sequences. Sharing enjoyment in play develops a sense of connectedness with others.

2. How Children with ASD Play

Children with ASD may exhibit a range of play behaviours. The range of the play behaviours is dependent on the child’s level of development and the accessibility of supports and structure in his/her environment. From earlier to later developmental levels, these behaviours can range from:

Appearing uninterested in objects, toys and peers
Repeating actions with objects (e.g., spinning the wheels of a toy car, or lining up blocks).
Limiting play sequences: only appropriate single actions with toys (e.g., shaking a maraca,pushing a car on the floor, or swinging on playground equipment).
Creating more elaborate play sequences involving two or more actions with toys (e.g., putting a ball in a hole, hammering, building a block tower then crashing into it with a car, stringing beads, using a marker on paper, feeding a baby doll with a spoon).
Linking related play sequences (e.g., putting the doll to bed, waking it up, feeding it).
Displaying organized play (e.g., initiating play with an object, using it appropriately, putting it away and finding another object).

3. Why Play is Difficult for Children with ASD

This is not well understood. The possible reasons include difficulty with:

Attending to functional play aspects of the toy or object
Adjusting to novel or sensory qualities (e.g., noisy toys or those with certain tactile qualities)
Imitating the actions of others
Generating novel ideas about how to play
Knowing how to initiate, sustain, and end a play activity (changing with the natural flow of play)
Understanding how to share the enjoyment of play with others

4. Supports for Play Needed for the Child with ASD

Almost all children with ASD need support to develop their play skills. These supports might include:

Setting up the environment so that the child is able to focus (see Module 2)
Engaging the child in what interests him/her and can be jointly enjoyed
Gradually introducing new toys and sensory experiences because some children need to be exposed to a new toy for a while before initiating a purposeful interaction
Task analysis -Breaking play down into steps (see Module 4)
Modeling how to play with the toy
Guiding the child to play with a toy or piece of equipment and gradually fading support
Encouraging the child to imitate his/her peers
Providing visual supports so the child can be a more independent player (choice boards or mini schedules (see Module 2)
Providing rewards or favourite play activities alternated with successful play attempts
Creating desirable opportunities for the child to learn
Generalizing play sequences into a social context (e.g., a teacher facilitating a game with a child and his/her peers)

Always provide positive feedback and reinforcement for appropriate play. If this is a new skill the child is learning, s/he will need more validation and higher praise at first. Remember, to see a behaviour or a skill again the child must be validated and reinforced.

Adapted from the Denver Model Treatment Manual, 2001

Teaching Adaptive Behaviours

1. Definition of Adaptive Behaviours

Adaptive behaviours are skills that support basic daily living functions (e.g., using a fork, putting on boots, blowing your nose).

Adaptive behaviours are usually sequences of movements put together to achieve a specific outcome (e.g., eating, dressing, toileting, hygiene activities, chores, and sleeping). These skills usually occur in the context of daily routines, in a particular place, and at a particular time each day.

Adapted from Steps to Independence, 1997

2. Difficulties with Adaptive Behaviours

Delays in learning adaptive behaviours can be caused by difficulties with:

Initiating and continuing a sequence of movements (motor-planning challenges)
Heightened awareness of sensory qualities (e.g., textures/tastes of food; feeling of clothing; sound /feeling of hair-cuts or shampoos)
Focusing on a task
Gross and Fine-motor skills
Cognitive delays

3. How to Work with Adaptive Behaviours

The principles of OBSERVE, THINK, TRY are recommended.

Find a way to measure and record how the child is progressing. It is a good idea to keep the chart simple and handy.

Here is an example

The chart could be kept near where the skill is being taught so that staff can easily check off (e.g., on a clip board high on wall by the snack table with a pencil on string taped to it). (See Module 4, for more examples of charting).

Set up a way to communicate with other staff and the parents. Ongoing communication between the team members is imperative in successful teaching. Talk to staff and parents about strategies used, or create a communication binder or notebook to travel with the family. Implement the plan and record progress. Evaluate progress and alter the plan as needed. The child may not demonstrate signs of change immediately, so it is important to remain consistent with the plan for at least two weeks. The plan may need to be modified depending on the child’s progress within a reasonable amount of time. Set new objectives on a regular basis, or at least every 3 months.

4. Teaching Adaptive Behaviours

In order to help a child experience success, she/he must be provided with the right level of support and rewards. As the child progresses, the frequency of support/prompts and rewards can be gradually decreased. This helps the child to succeed by working in small steps towards the desired skill.

Consider the learning style of a child with ASD.

May find it challenging to follow verbal directions and imitate
Usually responds well to visual supports and physical guidance

Ways to help a child learn an adaptive behaviour skill:

Teach within the natural routines when the skill is needed
Teach the child to use cues from the environment (e.g., initial brief verbal instruction to get dressed, the sight of clothes in the cubby, a picture schedule)
Reduce verbal cues (reduces reliance on adult presence)

For some children, modelling the task will be enough to help the child learn the task. For many children with ASD, once the initial direction has been given and a model has been shown, the child may require guidance to ensure success.

Sometimes it can be most effective to give and fade support throughout all the steps of a task. This “whole task” approach means that the child does the parts they can in the sequence and is prompted for the other steps.

In other situations, it may be best to focus on helping the child complete only the first step or the last step of the skill. From there, you can build on this initial success by focusing on the next step until the task is complete. These approaches are called, respectively, “forward chaining” and “backward chaining”. An example of backward chaining is as follows: first help Billy to put on his sock until the final step of pulling it up past his ankle. Next time, assist until the sock is barely over his heel, and let him complete the two final steps, pulling up the sock over the heel and past the ankle. In this approach, you are setting up the child for success. Remember to heavily praise the child for completing the task. This will motivate him/her to continue practising the new skill as the task gets more challenging.

If the child can match pictures to objects, you can make a picture schedule of some of the steps involved in certain skills (seen in Module 4). Place the picture schedule where the task normally takes place. Guide the child (as needed) to point to each picture to help complete the steps. Then guide him/her to do the step indicated. As the child progresses and moves through the steps independently, remove the steps s/he has mastered from the chart.

Keep the chart as long as the child needs support to go from one step to the other (e.g., a Velcro strip near the child’s cubby may have pictures of clothing items in the sequence. Guide the child to point to first picture, find the item, put it on, then turn over the card, and point to the next card, find the item, put it on, etc).

Try to provide a natural consequence as a reward for completing the skill (e.g., being able to go outside after getting dressed or drinking juice after fetching and pouring it).

Many repetitions may be needed to gain independence. The child receives support to complete what he can on his own. This gives the child a sense of mastery and reduces frustration.

5. Problem Solving

What About the Child Who Does Not Like to be Touched or Guided?

Children who do not like to be touched should be approached more slowly and gradually. Look for types of touch that the child does tolerate. Often firm, broad touch is more acceptable than lighter or more tentative touch, and it can help to relax a child. Some children prefer to be touched on the feet or back. Look for pleasurable ways and times in the day to provide touch experiences so that the child gradually accepts being touched. A good way to do that is through “sensory social routines” such as familiar songs and games that incorporate pleasurable touch experiences. These can be done at the beginning, end, and at various times throughout any activity.

Review

Children with ASD often have delayed play skills.
They benefit from direct teaching of play skills and additional supports for independent play.
Children with ASD may have delays in learning adaptive behaviours or the skills of daily living.
Adaptive behaviours can be supported and taught in a systematic way within the daily routines in which they occur, as well as in specific teaching sessions.

Next module: Enhancing Social Skills

Autism Spectrum Disorder: Supporting Children and Youth – Module 7

Enhancing Social Skills

Introduction

Children with Autism Spectrum Disorder (ASD) experience challenges in social relationships. A deficit in social interactions and communication is one of the identifying characteristics of ASD. Children with ASD may appear uninterested in social interactions and may have difficulty understanding the behaviour of others. Children with ASD may desire social engagements but lack the necessary social skills to develop these relationships.

What are Social Skills?

Social skills are the verbal and nonverbal behaviours that allow people to participate in various social situations.

1. Why Teach Social Skills?

We understand that children with ASD learn new skills differently (see Module 4). In the same way, social skills must be explicitly taught. Children with ASD take in information about the world and respond to that information in a different way. This has a profound effect on their ability to interact with people.

Social and communication skills are highly interdependent. Difficulties in both of these areas have separate and joint effects on an individual’s ability to develop and maintain relationships with others. Children with ASD may experience a lot of confusion and frustration as a result of these difficulties. This can lead to secondary problems such as tantrums, or other challenging behaviours. Promoting social and communication skills can be critical in the overall well-being of a child with ASD.

2. Social Development Milestones

Typically-developing children show the following social behaviours by approximately the ages indicated in brackets:

Smiles at familiar adults (1½ months)
Imitates simple actions (9 months)
Engages in a simple game with others, such as rolling a ball back and forth (1 year)
Imitates actions of another child (1½ years)
Watches other children play and attempts to join briefly (2 years)
Plays alone, in presence of other children (2 years)
Plays simple group games (e.g., Ring Around the Rosy) (2 years)
Begins to take turns (3 years)
Forms temporary attachment to one playmate (3½ years)
Takes turns and shares without supervision (4½ years)
Plays cooperatively with up to two children for at least 15 minutes (5 years)
Has several friends, but one special friend (5 years)
Plays cooperatively in large group games (5½ years)

(Adapted from A Work in Progress, 1999)

Social Skills of Children with ASD

The social skills of children with ASD may differ from those of typically-developing children (see Module 1).

Below are some characteristics of social skills that children with ASD may demonstrate:

Often shows attachment to familiar adults, such as a parent, but may be uninterested in other adults and children
May demonstrate an awareness or interest in others but may not have the social skills to interact appropriately
May have difficulty imitating peers
Imagination and pretend play are limited and play is generally repetitive

Identifying Social Skills

1. Social Skills to Target for Young Children with ASD

(Note: overlap with early communicator skill targets)

Attending to objects
Being with other children
Imitating
Sharing
Turn-taking
Asking for help
Using social conventions (e.g., “Please”, “Excuse me”)
Voicing greetings and farewells

2. More Advanced Social Skills to Target for Children with ASD

Displaying peer entry skills
Offering help
Asking someone to play
Playing a game
Identifying emotions and other nonverbal cues

Self-calming techniques and social skills

Self-regulation may be essential for promoting appropriate peer interactions, although it is not considered to be a “social” skill. The child’s ability to manage his own body, mind, and emotions make successful inclusion with peers more likely. These particular adaptive skills may at first require a great deal of adult support. See Module 2 for adaptations to the environment that assist children in coping with a group setting. See Modules 3, 4, and 6 for strategies to teach adaptive “self-calming” behaviours.

Social Skills

It is important to observe both the child and the child’s peers in order to ensure that the social skills activities are as follows:

Consistent with the child’s likes/dislikes
Lending themselves to interaction with others
Age appropriate
Peer appropriate

NOTE: Although making activities age and peer appropriate is the goal, the child’s skill level and interests must also be taken into account.
Toys, games, and ideas to encourage social interactions:

“See & Say”
Simple foamboards/ puzzles
Dolls, stuffed animals
Shape sorter
Swings
Cars, vehicles
Musical videos
Music
Peek-a-Boo
Action songs
Colouring
Activity Centre
Solitary play
Ball
Tea Party/ Birthday Party
Chase
Ring-Around-the-Rosy
Lego, Blocks
Cars, Vehicles
Marble maze
Puzzles
Dolls, action figures
Painting
Play kitchen
“Candy Land”
Matching games
“Snakes & Ladders”
T-Ball
Soccer
Construction play
Pretend play
Socio-dramatic play

Adapted from A Work in Progress, 1999

1. Strategies for Teaching Social Skills

Joining In

Children with ASD may have challenges initiating and including others in their play. Start with games that do not require toys, such as physical activities like tickling or chase. Structured activities are predictable and become routine. They will eventually leave little to interpret and can be easily taught. Games with repetitive actions, sounds, words, and movements/sensations that the child enjoys encourage social interaction. Singing games like “Ring-Around-the-Rosy” or “Row, row, row your boat” encourage simple social engagement and turn taking.

During “Row, row, row your boat”, pause and allow the child to take a turn by filling in a word and/or the action. Then take your turn and keep the song going. Provide prompts when necessary for the child to take a turn at first. The more practice a child has had with joining activities with another person, the more successful s/he will be when playing with other children.

Tasks that highlight a child’s strengths and interests may be used in peer-directed activities. For example, a child with an interest in weather might take charge of posting the day’s weather on the calendar during circle time.

Play with Peers

Promote play with other children by choosing activities that are predictable, structured, and of interest to everyone involved. Consider games the child with ASD already knows and has played independently. Determine distinct roles to encourage cooperative play, sharing, and turn taking. Adult prompts and modelling may be required to initiate and sustain play interactions among peers. It is important to remember that the goal is to teach the child with ASD how to play with his/her peers.

Here are some toys and combinations that provide opportunities for cooperative play at various levels:

Ball or car: “sender” and “receiver” (on floor, down a slide)
Bubbles: “blower” and “popper”
Toys in the sandbox: “hider” and “seeker”
Containers, various materials: “filler” and “dumper”
Talk about a pre-selected topic of interest: “asker” and “teller”
Cooperative building (Lego, blocks): “builder” and “knocker down”, “block chooser” and “builder”, or take turns placing blocks
Wagon: “rider” and “puller”

(Adapted from: Social Skills for Young Children, IWK Health Centre; and A Work in Progress, 1999)

Exercise: Developing Play with Peer

Choose a cooperative peer and ask them whether they would like to play a game with ___________ (the child with ASD). If the peer agrees, arrange a brief game during which you may provide the children with prompts when necessary to ensure some success for the child with ASD (e.g., popping the bubbles, completing the puzzle, knocking down the tower of blocks). Be sure to build in positives for the peer partner (e.g., praise, access to another preferred activity after the game).

Click here to see a sample answer

Visual Supports

Visual strategies have been identified as effective supports for children with ASD in their communication and cognitive development (Modules 2 and 5). They can also help children with ASD develop social skills. Visual aids act as a reminder and breakdown the expected tasks involved in appropriate behaviour in social routines.

Cue Cards
Cue cards are visual aids that remind the child what to do in social situations. They are pictures or symbols used to replace or reinforce verbal directions, or used to quickly and quietly redirect a child. Cue cards can be used to prompt appropriate social scripts, such as “It’s my turn,” or “Hi”. Cue cards also promote appropriate behaviour like “Line up” or “Hands to self”. For cue cards to be effective, consider the child’s strengths and abilities.
Social Scripts
Social scripts are visual aids used to demonstrate language to the child with ASD in social interactions. They are arranged to depict appropriate behaviour in a social situation. Scripts typically involve a series of visual cues. For example, a script for greeting someone on arrival at preschool could be three visuals depicting: (1) Open door; (2) Say “Hi” to____; (3) Stop (wait for ____to say “Hi”).
The picture sequence should be placed next to the door or given to the child by the parent to view before entering the room.
Visual scripts can also be used to guide a child through a play activity with another person. For example, to help a child to participate in a bubble-blowing activity, a visual script could be used to cue the child to: (1) wait for the other child to blow bubbles; (2) pop the bubbles; (3) say “My turn”; (4) put out a hand for the container of the bubble solution.
Note: The pictures in a visual script should be aligned and read in a row; either horizontal (left to right) or vertical (top to bottom) depending on what the child is used to.
Social Stories
A social story is a short story that describes a situation, concept, or social skill. It includes information about what to expect in the situation and why. These stories may improve the social understanding for children with ASD. Social stories can be written to address any number of topics, including self-help skills, social interactions, changes in routine/environment, and behavioural strategies. Social stories are written in the first or third person to provide a literal and concrete understanding of appropriate behaviour. Carol Gray’s The New Social Story Book – Illustrated Edition provides guidelines for social stories.
An example of a social story for a simple behaviour is as follows:
Social stories should be written to match the ability of the child. In general, social stories are suitable for older children with stronger language abilities. To make social stories more enjoyable, they can be made into picture books with photos or illustrations on each page. Taking photos of the child in appropriate situations allows the child to be part of the story. Social stories can also be combined with music. This may assist some children to better remember the information. For social stories to be the most effective they need to be read to the child on a consistent and (ideally) daily basis when the child is calm so that s/he can process the information. When the child is met with the same social situation in the future they are hopefully able to recall the social story.

Review

The following are key points to remember:

Social skills are significantly impaired in children with ASD.
This impairment compounds difficulties in other areas, such as communication and behaviour.
Social skill targets have to be chosen carefully based on criteria such as age and interests.
The use of games, visuals and social stories are three of the strategies that can be used to help a child to develop appropriate social skills.
Plan activities that naturally bring children together.
Facilitate interaction with peers by providing the child with peer-directed tasks, and give prompts as needed.
Efforts should be made to generalize social interactions across different settings and people.

Next module: Working Together

Autism Spectrum Disorder: Supporting Children and Youth – Module 8

Working Together

Introduction

The complexity of the needs of children with Autism Spectrum Disorder requires the integrated efforts of a community. This includes family, educators, health care providers, and others. It is important to facilitate collaboration among the child’s family and professionals in order to work towards established goals to best support the child and his/her family.

Who are the Team Members?

Most children are born into families with community support. When a child has extra support needs they become part of a larger community. This community may include different professionals and services such as child care centres, early intervention programs, health care services (e.g., speech-language pathologists, psychologists, physiotherapists, physicians, occupational therapists, nurses), community services (e.g., social workers), and recreational programs. Each part of the community plays a specific role and brings a different expertise to developing a good, integrated program.

Parents are the experts and guardians of their child. They live with the child and know his/her likes, dislikes, tendencies, and personality. The family’s input is essential in the development of goals for a child’s program.

A few principles to guide interactions with parents and family members:

Treat the parents’ views with respect. It is important to ensure that the relationship between families and professionals is collaborative and respectful.
Maintain an objective perspective. Every family is unique and there may be many factors involved when making decisions. Treat the family as a unit, focusing on balancing the needs of all members involved, including siblings.
Keep in mind that being a parent of a child with ASD brings new stresses to a family’s daily life.
Professionals are guides, not experts
Collaborative relationships involve a cooperative approach to problem solving and support. They require openness and sharing.
Ultimately, the family will maintain responsibility for decisions involving the child with ASD. Professionals must realize that their involvement typically constitutes only a fragment of the total picture for the child and family
Our goal is to create a partnership with the parents while working with the child. Creating shared goals for the child and respecting what every professional and parent/family member brings to the table helps the child to reach those goals.

Modified from Working with Families: A Developmental Perspective, 1987.

Team Members:

Family

Family members will typically have detailed knowledge about the child’s daily life. It may be helpful to obtain information about:

Play activities the child enjoys
How the child communicates at home
How you can communicate best with the child
Activities the child does not enjoy
Strategies that help the child to calm down
Rewards or reinforcers that motivate the child to learn a new skill
Times of the day the child prefers to rest and relax and times the child prefers to be active
The child’s preferences related to the following: positioning, diet, temperature, lighting, and sound level
Special needs related to health and development such as toileting, dressing, and grooming

It would be beneficial to maintain ongoing communication with the family about their hopes and dreams for their child and anything that may be of concern. Families are a great source of information and resources about ASD to be shared with other team members.

Clinical Psychologist

A clinical psychologist has in-depth graduate training in learning and behaviour. S/he has the necessary training to administer and interpret formal psychological tests, diagnose, and provide intervention services for individuals with ASD. Psychologists examine children’s verbal and nonverbal cognitive skills and adaptive behaviours (e.g., self-care, social, motor, play). With training in behavioural-intervention methods, they can assist in developing and teaching programs for children with ASD. They are also equipped with professional skills to provide families with coping strategies to get through stressful circumstances.

Early Interventionist

Early interventionists are trained and experienced in working with families and children with special needs. They come from a variety of backgrounds, including special education, psychology, and early childhood education. They help families identify goals and organize resources. Activities are designed by early interventionists to complement the family and the child’s routine.

Occupational Therapist

Occupational therapists focus on functional and developmental needs. They examine a child’s fine motor skills, sensory processing, visual perception, organizational difficulties, oral/motor development, and seating/mobility needs. They pay particular attention to motor planning abilities related to the development of self-care, play, and social interaction skills.

Physician

Several different types of physicians may be involved in a child’s care, depending on his/her individual needs. The family physician makes referrals to specialists such as pediatricians, developmental pediatricians, neurologists, and psychiatrists. A pediatrician has special training in children’s health needs. Pediatric neurologists, developmental pediatricians, and child and adolescent psychiatrists have additional training and experience in diagnosing and managing certain aspects of child development and behaviour. Physicians are responsible for the management of medication. Neurologists typically also become involved when a child has a seizure disorder. In different centres, one or more of these specialists may be involved in the care of children with ASD.

Social Worker

Social workers have specialized training in family functioning. They gather information about the family history, relationships, and supports. They also provide support for the management of family stress and communication. Social workers typically have a good appreciation and awareness of community supports. They are strong advocates for families to access additional financial and recreational help, respite care, and social support.

Speech-Language Pathologist

Speech-language pathologists observe, evaluate and develop interventions to promote children’s communication skills. They will examine the child’s ability to understand communication (receptive language), ability to communicate with others (expressive language), social use of language (pragmatics), ability to control their tongue, lips and jaw (oral-motor functioning), ability to produce speech sounds (phonology/articulation), pitch, loudness, resonance (voice), and smoothness of speech (fluency). The speech-language pathologist may also assess and develop interventions to promote social interaction and play skills.

Other Professionals

Many other professionals may be involved, depending on the child’s needs. Physiotherapists provide support for the development of gross motor, mobility, and play skills. Nutritionists provide counselling and support regarding the dietary challenges that are common in children with ASD. Audiologists assess hearing and ophthalmologists assess vision. Geneticists are often involved when examining possible causal factors in the child’s disorder, as well as when families are considering having more children.

In the wider community, children with ASD and their families may also benefit from extended family, informal or formal support groups (e.g., autism societies, Association for Community Living), spiritual counselling or membership in a religious community, recreational programs (inclusive or specialized), opportunities to access respite care providers, and a variety of other supports. Each family will differ in how they define the team of essential supports for their child and themselves.

Behavioural Therapist

Many children with ASD access behavioural therapy in a group setting or on a one to one basis . Behavioural therapy can help the child to learn more appropriate behaviours and ways to express him/herself and work at decreasing challenging behaviours.

Exercise: Describing Team Members’ Roles

THINK about a child with ASD at your centre.

TRY to generate a list of the various professionals involved in the child’s care of which you are aware.

Describe your understanding of each team member’s discipline and role in the child’s care. Remember that not all information needs to be shared with everyone, so you may not be involved personally with all of the child’s team.

Click here to see a sample answer

How Does the Team Communicate?

It is helpful to have discussed methods of communication with family members before the child enters a child care centre. This ensures that the parents will know how to communicate their concerns to you when they arrive. It also helps parents to know how you will share your observations with them. It may be beneficial to consider keeping a formal record of the communication strategies a family would like to follow.

Program Plans

A program plan is a document designed to facilitate communication among members of a team that formally identifies plans for a child’s program. Different terms are applied to program plans based on the specific goals and objectives of the plan. For example, a child may have a very specific behavioural program plan to teach a particular skill.

This plan might include details such as the following:

Teaching Objective
Environment/Setting
Activity
Equipment/Material
Prerequisite Skills
Teaching Method
Step 1
Step 2
Step 3
Consequence(s) for correct performance
Consequence(s) for incorrect performance
Plan for generalization and maintenance
Mastery criteria

Although you may develop some specific behaviourally-based program plans, you are likely to also need a plan to cover various components of a child’s program. Routine-based program plans are often developed in conjunction with early interventionists to incorporate teaching strategies into a child’s day-to-day routine. Staff members in early childhood education centres typically develop Individual Program Plans (IPPs) or Individual Education Plans (IEPs) to describe a child’s individualized education, or centre-based program. Increasingly, as intervention teams are developed, there is a focus on the development of Individual Family Service Plans (IFSPs). As part of the IFSP development, the family, centre staff and other team members meet to create a document that focuses on the family and the child’s development across a variety of natural environments.

There are many resources available to assist families and professionals to develop IFSPs and IPP/IEPs (see end of Module). It is recommended that early childhood educators and/or professionals working with children with special needs pursue additional training to gain experience in understanding and developing these important documents. As a guideline, here is a brief outline of the features of an IFSP and an IEP that has been adapted from The Individual Family Service Plan, 2000 and Creating Useful Individualized Education Programs (IEPs), 2000.

Individual Family Service Plan (IFSP)

Records and guides intervention program
A written document to facilitate communication among team members
Includes information about the child’s developmental status (e.g. physical, cognitive, communication, social, and adaptive skills)
Includes information about the family’s strengths, concerns, priorities, and resources
Contains a plan to achieve goals/desired outcomes
- Focus on developing particular skills to achieve functional outcomes
- Procedures and timelines are identified
- Service providers and the frequency of service delivery is identified
Promotes intervention within natural environments
Identifies a coordinator for contact as well as contact numbers for other people/professionals available for support
Provides a dynamic document that is regularly reviewed and revised

Individual Education Plan (IEP)/Individual Program Plan (IPP)

Records and guides education program
Creates a written document to facilitate communication between the student, family, teachers and other service providers
Includes information about the child’s current academic performance and may include additional information regarding strengths, weaknesses, behaviour, and school history
Identifies expectations regarding the child’s learning that are modified from, or alternative to, those of the typical program curriculum
Will include a transition plan to school and/or other appropriate services
Contains a plan to achieve the goals and objectives
Identifies aids, services (service providers and frequency of service delivery) and modifications
Includes information regarding how communication occurs with parents/family
Provides a dynamic document that is typically reviewed at least annually
Includes information regarding transition services

IFSPs and IEP/IPPs have many common features. The IFSP focuses more specifically on the family. The IFSP also has an emphasis on intervention in natural environments. Typically the IFSP has been developed by a team from a variety of settings and therefore facilitates communication among all those involved in a child’s life.

It is important to prepare accordingly when you work with families and facilitate or attend an IPP/IEP or IFSP meeting. The degree of preparation you need will depend upon whether you are facilitating or attending. Some of the following guidelines may be helpful for your preparation, particularly if you are the facilitator:

Communicate first with the family regarding its preferences for participation, a meeting time, and which individuals to invite.
Invite all pertinent team members (have a list of names and telephone numbers), using the input from the family.
Gather relevant documentation and review it prior to the meeting (e.g., reports, work samples).
Prepare and circulate an agenda
Arrange seating to facilitate communication.
Welcome all attendees.
Identify a “recorder” to take minutes of the meeting and ensure they are distributed to all members afterwards.
Create a positive environment and encourage each member to express his/her opinions.
Keep to the schedule (e.g., start and stop on time).
End on a positive note with documentation of the intervention plan and agreed upon date(s) for follow-up meeting(s).

Regardless of your role you are most likely to have a positive meeting when you are able to participate in an open dialogue, respect and value the input of others.

Communication Books

A communication book helps to promote two-way communication between centre staff, families, and other professionals. A home-school communication book provides an opportunity for parents to share information about a child’s home routine that may affect the child’s behaviour at the centre. For example, if a child has had a short sleep and is likely to be tired the next day you may decrease the expectations placed on the child. A communication book also provides an opportunity for you to learn about significant events the child has experienced. One may use this information to provide activities that cater to the child. For example, if you know the child went to the swimming pool on Saturday, you might notice the child’s splashing gesture (which can be elaborated), or you can talk about how the water feels.

A communication book also helps families know more about what the child does during the day. Children with ASD may have challenges communicating about the day’s events. Short written notes, work samples, and photographs are all helpful ways to communicate. It may be useful to talk to parents to learn which details they would be most interested in learning. It helps to be specific about the events of the day and to share accurate and positive information. For example, rather than reporting that today was a “bad day”, try to say what triggered the behaviour of concern, what the child did exactly, and how it was handled. Then you might report how you are considering managing the situation if it arises another time.

Parent Visits

It is helpful for parents to observe their child interacting with others. Having an “open door” policy so that parents feel welcome to observe their child and the program helps to encourage a collaborative approach. Other professionals may also wish to observe the child in the centre. This may provide the professional with a broader understanding of the child, and create a good opportunity for an on-site consultation about specific issues.

Communicating with the Team to Meet a Challenge

When a child is making progress with their learning objectives, the program plan team may only be periodically involved. When there is cause for concern about changes in behaviour or progress, however, the need for collaboration becomes necessary for all team members.

Members of the child’s team may decide to meet for a number of reasons. For example, they may need to revise a learning objective due to changes in progress or new behaviours. The concern must be clearly stated and communicated among the team members. Be as specific as possible in describing the ABC’s of the situation of concern, or the nature of the child’s difficulty with a particular objective (e.g., Are previous rewards no longer effective? Has the child come to rely on a specific prompt?).

In cases of behaviours you want to reduce/eliminate, use the information from your observations to evaluate the function of the behaviour. That is, carry out a functional analysis (see Module 4). This preliminary information may be invaluable in helping you to define the problem and to decide which team members’ assistance would be beneficial. You may need the parents’ permission to contact other members of the team. Consult your director if in doubt.

Exercise: Choosing a Team Member to Consult

Read the following scenario:

How would you begin to examine the problem?
What observations might you make, and what information will you need in order to develop a plan to address the problem?
What are your initial suggestions for changes?
If your initial plan does not produce an improvement in the situation within approximately two weeks, whose assistance (e.g., what professionals) might you consult? What would you expect their roles to be?

Click here to see a sample answer

Transition – Preschool to School

Transitions can be challenging for individuals with ASD. Young children and families experience a variety of transitions. The change from a child care setting to school is a significant transition for any child. For those with ASD, a smooth transition may require a higher level of planning. Successful transitions are possible with careful preparation by a committed team of parents and professional partners.

In most jurisdictions, some members of the child’s team (e.g., some health care providers and other professionals) may remain part of the child’s team when they go to school, while others (e.g., early childhood educators) will not, and a new group of providers will become involved (educators and other school-based professionals). Strong transition services prepare families and children for the move, support them during the move, and maintain contact with them to address problems that may arise after the move.

As eligibility for school entry varies across jurisdictions, the child’s parents and child care providers need to be aware of the local eligibility criteria and of the transition process in your school district.

Some school districts have established steps to follow in preparing to support a child with special needs at a school. In other districts, the process could be less formal, or based more on the experience and accessible accommodations of the particular school. Parents often require support to ensure that a plan is in place for their child’s school placement. In some communities, private schools are being established for children with special needs, including ASD. Families may need support as they explore a range of options available to them and their children. During this time there may be periods of uncertainty and additional stress for the family. Preschool educators are often experienced supporters when working with families and children with special needs and can be an asset to a child’s transitional team.

Public and professional awareness of Autism Spectrum Disorder has grown a great deal in recent years. Children diagnosed with ASD vary widely in their skills and their behaviour. The staff of any given school may be unfamiliar with the wide range of abilities and characteristics of children with ASD. Information about the individual needs of the child you are working with must determine the services provided to him/her.

It is beneficial when families provide documentation about the child’s special needs in the form of reports from professionals who have assessed them or provided intervention services (e.g., speech-language pathologist, psychologist).

Usually a transition meeting will be held in the spring prior to the child beginning school. This meeting brings together parents, preschool educators, other consultants (e.g., speech-language pathologist, occupational therapist, psychologist), and those who will be contributing to the school-based program (e.g., principal, classroom teacher, resource teacher, speech-language pathologist). The goal of this initial transition meeting should be to devise a plan to introduce the child to the school, and vice versa, in as systematic a way as possible. Other meetings will be required to develop the school-based IPP (or IEP: Individual Education Plan or Program), which is often an outgrowth of the preschool IFSP.

The child’s parents may share written reports in advance of this conference, where the focus will be on facilitating a smooth transition from preschool to school. Information from the preschool program will include a description of the setting and routines, as well as the child’s individual program plan and records of his/her accomplishments. Preschool educators have the important role of sharing their knowledge about and experience with the child in a group setting. This information is crucial in ensuring a successful transition into school. Decisions such as the type and amount of support (e.g., dedicated time from an educational program assistant) may depend on a detailed analysis of the child’s ability to learn and interact within peer groups.

Remember, successful transitions are characterized by:

Children’s positive attitudes
Parents’ positive attitudes
Teacher’s provision of developmentally-appropriate experiences
Communities that provide support – sharing, cooperating, and coordinating across agencies

Try to be mindful of the differences in how preschool and school systems operate with respect to the number of children, types of learning environments (including physical spaces) and the different administrative structures and range of professionals involved. While information from the child care setting is valuable, one cannot entirely predict how a child with ASD will adapt to the demands of the school setting, based only on their preschool experiences.

Review

Families of children with ASD usually require many professionals to support the needs of their child and the family, but ultimately the goal is to meet the family’s needs. The collaborative efforts of team members should be directed toward empowering the family and helping to ensure that the child’s care and education match his/her needs. Good communication is a key to effective collaboration. When major transitions take place, special care must be taken to ensure that appropriate information is passed along at the right time, and in the most helpful way. Early childhood educators play a key role in providing observations of the child in a group setting, and in reporting the effectiveness of specific intervention strategies for the individual child.

Enabling Person-Directed Planning for Augmentative and Alternative Communication (AAC) Users

The Enabling Person-Directed Planning for AAC Users guidebook, is designed to help persons who use augmentative and alternative communication take an active role in the person-directed planning process. The guidebook outlines a 5-phase process, based on established best-practices in AAC and transition planning for persons with disabilities, for developing partner communication strategies with planning recipients who use AAC.

Enabling Person-Directed Planning for AAC Users: Guidebook

Guidebook

Once you have read through the guidebook, you can download the specific toolkits (sample checklists) and blank templates that are included within the guide for use later.

Autism Spectrum Disorder (ASD)

Fact Sheet

What is Autism Spectrum Disorder (ASD)?

Autism Spectrum Disorder (ASD) is one of the most commonly diagnosed developmental disorders in Canada. It is characterized by challenges with social communication skills /interaction and restricted / repetitive behaviours. Autism is known as a spectrum disorder because characteristics vary greatly from person to person and everyone with a diagnosis of ASD has a distinct set of strengths and challenges. It is estimated that around one third of people with ASD also have an intellectual disability.

The cause of autism is not yet understood but doctors believe that it is caused by a combination of genetic and environmental influences. Because autism has been found to run in families this continues to be an area of interest to researchers. ASD is considered a lifelong disorder, however, supports and services can greatly improve how individuals are affected and can improve their ability to function day to day.

How is it manifested?

Signs of autism usually appear by the time a child is 2 or 3 years of age, but it can be diagnosed as early as 12 -18 months of age.

Parents and caregivers may notice that a child has missed language milestones such as not having any language by 16 months of age or no two- word phrases by their second birthday. Some children with ASD may lose language or previously acquired skills.

Children with ASD may experience a variety of sensory sensitivities to sounds, smells, light levels and textures. They can be sensitive to the fit of their clothing and be particular about what they wear. They may refuse to wear clothing that feels too tight or loose, has sleeves that are an uncomfortable length or has irritating tags or seams. Children with ASD may appear to have a high pain threshold and may be able to tolerate extremes of temperature without showing discomfort. Sensitivity to textures can also lead to challenges with feeding as children can develop very strong preferences for certain types of foods and refuse to eat other types.

Gastrointestinal issues, seizures, disrupted sleep patterns, anxiety and depression are some of the common physical and mental health effects experienced by children and youth with ASD.

Some behaviours that parents and caregivers may observe, the child

may not point out or show things of interest to others. They may not attempt to get the attention of their parent or caregiver.
may lack eye contact with people who are unfamiliar (directing the child to make eye contact may make them uncomfortable and upset)
may not engage in back in forth verbal or non-verbal communication with others. They may not respond to the expressions on people’s faces and they may be observed to focus on objects.
may not wave or greet others spontaneously.
may appear to be content to spend extended periods of time on their own.
may not consistently respond to their name being called.
may avoid or ignore their peers or caregivers when they are approached and attempt to interact with them.
may move their hands or fingers in repetitive ways, they may rock or pace or may be seen to walk on their toes.
may show a lack of interest in toys or they may play in an unusual way – lining up toys, spinning or smelling them or repeatedly opening and closing a part of a toy. They may look for a prolonged period at an item and may like to hold things close to their eyes.
may become preoccupied with light and movement – flicking light switches, opening and closing doors or watching fans and wheels go around. It may be difficult to distract the child or get them to move on from these interests once engaged.
may experience difficulty with changes to their routine – they may have to perform tasks in a particular order, or they may become upset if things don’t follow the sequence.

Who is affected?

In 2018 the National Autism Spectrum Disorder Surveillance System (NASS) released the statistic that 1 in 66 Canadian children and youth aged 5-17 are diagnosed with ASD. Boys receive the diagnosis 4 times more frequently than girls although the ratio is likely closer to 3:1 as research suggests that girls with ASD, especially those without accompanying intellectual disability may be missed under current diagnostic procedures. Girls have also been found to be diagnosed with ASD at significantly later ages than boys.

How is ASD diagnosed or detected?

The first step in diagnosing ASD is for the family to discuss their concerns with child’s doctor or pediatrician. The doctor or pediatrician will refer the child to a developmental pediatrician for a formal developmental assessment to assess the following areas: social, cognitive, communication and motor skills. ASD is diagnosed when a combination of specific behaviours, communication delays, and/or developmental disabilities is confirmed.

In 2013, the American Psychiatric Association published the Developmental Statistical Manual 5^th edition (DSM–5). In previous editions individuals could be diagnosed with Autistic Disorder, Asperger’s Disorder, Childhood Disintegrative Disorder or Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). The DSM-5 now encompasses all four diagnoses under the umbrella of Autism Spectrum Disorder.

If the child receives a diagnosis of autism spectrum disorder, they will receive an accompanying severity level: Level 1 (requiring support), Level 2 (requiring substantial support), or Level 3 (requiring very substantial support).

Resources:

Autism Ontario

Autism Ontario provides information about programs and services available to people with a diagnosis of autism in Ontario. Links are provided to different chapters in regions of the province with local information and events. https://www.autismontario.com/

They also provide a newsletter that can be signed up for using the link below. https://www.autismontario.com/newsletter

Autism Speaks Canada

Autism Speaks Canada is a national Canadian charity that offers information and support to persons with autism and their families. https://www.autismspeaks.ca/

Geneva Centre for Autism

The Geneva Centre for Autism provides programs, training and resources for people with an autism diagnosis as well as their families and caregivers. https://www.autism.net/

They also offer a newsletter that you can sign up for using the link below. https://www.autism.net/newsletter

Ontario Government

Ontario.ca is the official website of the Ontario Government. The most up to date information on the Ontario Autism Program can be found at the link below. https://www.ontario.ca/page/ontario-autism-program

SNOW Inclusive Learning & Education

SNOW is a branch of the Inclusive Design Research Centre at OCAD University that focuses on Inclusive Education and Learning. They provide information and training about technologies and inclusive practices for both in and outside of the classroom. https://snow.idrc.ocadu.ca/

Surrey Place

Surrey Place supports children and adults living with developmental disabilities, autism spectrum disorder and visual impairments.

They also provide Coordinated Service Planning for children and youth with multiple and/or complex special needs and their families through the support of a Service Planning Coordinator. https://www.surreyplace.ca/

The content contained in this document is for general information purposes. It is not the intention to diagnose or treat a child.

All About Me

Creating Books to Share Experiences

Making a book with your child can be a special and enjoyable experience for both of you. It can increase your child’s self-esteem, while providing opportunities to develop his language and fine motor skills. When the book is finished, it will be a lasting memory for your child and family.

What is an “All About Me” Book?

An “All About Me” book can be created for your child. It is a special book that tells a child’s life story. Photographs, or mementos, of special events and milestones can be added to the book at any time. Celebrating your child’s accomplishments is important because it builds self-esteem and motivates him to continue learning. Finally, creating an “All About Me” book shows your child that he is loved, unique and special.

“All About Me” Book Contents

To get you started, we have created several sections that can be included in your child’s “All About Me” book. The book is an on-going project that you and your child can complete over time. Depending on your child’s interests and attention span, you may wish to include only a few sections. Here is a brief description of each section:

Hello!

This page should include a recent picture of your child.

My Birthday

If you have a copy of your child’s birth announcement you can add it to this section. You may also want to add a picture of him on each birthday.

My Family

You may want to have a page for each family member that includes their name and a photograph. Close friends can also be included in this section.

My School

Once your child starts school, you may want to add class photos. You can also add programs from school events, such as concerts, in which he has participated.

My Favourites

This is a great place to add information on your child’s hobbies and interests.

I Can!

A record of your child’s accomplishments can be kept in this section. Each time he reaches a goal, such as taking his first steps, tying his shoelaces or achieving another goal that he’s been working on, a new page can be added.

How to Make the Book

You will need:

a computer and printer
a blank scrap book
photographs or pictures from magazines
crayons, markers and stickers
glue

Steps:

Print the pages for the book found at the end of this document.
Glue the first page to the cover of the scrap book.
Complete each page by filling in the blanks and decorating the pages with crayons, markers and stickers. When there is space for a picture, either glue a photograph in the square, or have your child draw a picture.
Add each completed page to the scrap book.

Hints:

If you don’t have a scrap book on hand, you can make your own. Use some construction paper to make a cover, punch holes on each page, and attach it all together by tying a piece of string through all of the holes.
Make sure to leave some blank pages in each section. This way you can add extra pictures later on.
Whenever you add new pictures to the book, write a short sentence about what is happening, or who is in the picture.
The use of photographs is suggested because it makes the book more personal. However, if you do not have many photographs, you and your child can draw pictures, or cut them out of magazines.

Your “All About Me” book is ready to share!

Using the “All About Me” Book to Build Communication Skills

Develop Your Child’s Sense of Self-Awareness

Self-awareness is an important skill for any child to develop because it helps him understand that other people are different and separate from him. When a child has a sense of self-awareness, he will be able to communicate more successfully with other people.

Self-awareness involves:

Recognizing your face in the mirror or in a photograph.
Responding to your name when someone calls you.
Understanding that people need “personal space”.
Recognizing your name in print.
Understanding that everyone has different needs and feelings.

When creating the “All About Me” book with your child, encourage him to point to himself in photographs. Prompt him by asking, “Where are you?”, or “Where’s Jimmy?” If your child needs help, take his hand and point to his picture and say, “There you are!”, or “Look! It’s Jimmy!”

Once your child is able to identify himself in photographs, he can practise finding and naming family members and friends.

Making Choices

Encourage your child to make choices by looking at, pointing to, or telling you which item he wants to include in the book. This will provide him with opportunities to practise making eye contact with you and to learn ways in which questions can be asked and answered. To begin, it is best to present your child with two choices.

Here are some choices your child can make:

Which pictures or photographs to use.
Where to glue a picture.
What colour crayon to use.
Which stickers to use.

When he reaches school or goes to child care, your child may be better able to make choices and to share during play and other activities with his friends.

Increase Vocabulary

As you complete the book together, emphasize words with which your child is unfamiliar, to help him understand what they mean and to learn how to say or sign them. Talk about what is happening in each of the photographs that you are adding to the book. As you describe each photograph, emphasize the important words and point to them. For example, “Grandma is sitting under a tree.”

Here are some word categories:

Actions: in, out, on, under, sit, stand, walk, run, eat, drink
Activities: draw, paint, game, swim, cook, music, play
People: mom, dad, teacher, friend, brother, sister
Objects: book, bike, t.v., radio, doll
Places: home, school, park, library

For familiar words for your child, you can point to a person, object, or place and ask him to name it. “Jimmy! Who’s under the tree?” Another option is to say a word and ask him to point to it in the picture. “Jimmy, can you show me the tree?”

Conversation Aid

If the whole family is involved in creating “All About Me” books, your child will have many opportunities to participate in conversations by sharing materials and experiences with his brothers and sisters.

While gathering information to include in each section, you can try asking your child some questions. Here are some common social questions other children or adults might ask your child. For example:

How old are you?
What’s your name?
What games do you like to play?

Your child may not be able to answer these questions on his own, or right away.

You may want to coach him in answering a few basic ones. If your child communicates verbally, ask the question, then provide the answer yourself.

Keep answers as short as possible. For example, “Jimmy, how old are you?” Wait at least 5 seconds for your child to respond. If he doesn’t, you can say his age, “Four”. If your child communicates nonverbally, you can show him how to answer with a simple gesture. For example, holding up fingers to show how old he is.

Using the “All About Me” Book to Build Fine Motor Skills

By encouraging your child to help you put together his “All About Me” book you can also work on fine motor skills, such as gluing and pasting pictures, writing his name or cutting out pictures and shapes.

Gluing or Pasting

Pour some glue into a small container and encourage your child to apply it using a popsicle stick. Show him how to dip the popsicle stick into the glue and spread it on the paper. Point out how glue goes on the back of the picture. If a popsicle stick is too narrow for your child to grasp, try using a paintbrush with a wide handle. Some children do not like the stickiness of glue, or getting their hands messy. If this is the case, try using a glue stick.

Drawing and Writing

If your child has difficulty grasping narrow pencils or crayons, they can be enlarged with hair curlers or clay. You can also purchase some thicker or “chubby” crayons for your child. Depending on your child’s skill level, you can guide him to:

Hold a crayon or pencil and make marks on the paper.
Colour inside lines.
Make lines or circles.
Trace or practise printing letters.

If your child is interested in printing and writing, you can show him how to print his name. Start by printing his name and having him trace the letters, on his own, or with some help.

Cutting

Make sure you have a pair of plastic, child-safe scissors. Show your child how to hold a pair of scissors and make cutting motions before giving him some paper to cut. Once he is able to do this, sit beside him and hold out a thin piece of paper for him to cut. When he is able to cut on his own, have him cut out the larger shapes. You can help to cut out the smaller shapes, or finer details.

Download the All About Me template

Acquired Brain Injury

Fact Sheet

What is Acquired Brain Injury?

Acquired Brain Injury (ABI) is a non-degenerative injury to the brain that has occurred since birth. It can be caused by an external physical force, or by a disturbance of the regular metabolic order.The term “Acquired Brain Injury” includes traumatic brain injuries such as open or closed head injuries, and non-traumatic brain injuries such as those caused by

strokes and other vascular accidents
tumours, infectious diseases
hypoxia
metabolic disorders (e.g., liver and kidney diseases or diabetic coma)
toxic products taken into the body through inhalation or ingestion

How is it manifested?

unable to concentrate
misunderstands instructions
forgets instructions
tires easily
has difficulty learning new information or concepts
has difficulty planning complex tasks
has difficulty organizing ideas
has difficulty organizing school materials
has difficulty getting started on tasks
is easily distracted by surrounding activities

Brain injury may occur in one of two ways:

Closed brain injuries occur when there is a non-penetrating injury to the brain with no break in the skull. A closed brain injury is caused by a rapid forward or backward movement and shaking of the brain inside the bony skull that results in bruising and tearing of the brain tissue and blood vessels. Closed brain injuries are usually caused by car accidents and falls. Shaking a baby can also result in this type of injury (Shaken Baby Syndrome).A concussion is a mild type of closed Traumatic Brain Injury (TBI), caused by a bump, blow or jolt to the head or body which causes the brain to move back and forth in the skull. Without attention, diagnosis and treatment, the damage to the brain does not have the opportunity to recover, and can easily worsen.
Penetrating, or open head injuries occur when there is a break in the skull, such as when an object pierces the brain.

Who is affected?

According to Brain Injury Canada 160,000 Canadians sustain brain injuries each year. Incidence (and reporting rates) are rising. Over a million Canadians live with the effects of an acquired brain injury. About 50% of all acquired brain injuries in Canada are caused by falls and motor vehicle accidents.

The Think First National Injury Prevention Fundation reports that thirty per cent of all traumatic brain injuries are sustained by children and youth, many of them while participating in sports and recreational activities.

The incidence and prevalence of brain injury outnumbers breast cancer, spinal cord injury, multiple sclerosis and HIV/AIDs combined.

Each year, two million people in the U.S.A. experience a brain injury, and 99,000 suffer from long-term disability. Over five million people today are living with an ABI-related disability.

Recovery:

Most studies suggest that once brain cells are destroyed or damaged, generally, they do not regenerate. Recovery after a brain injury can take place in some cases. However, as other areas of the brain compensate for the injured tissue, the brain learns to reroute information and function around the damaged areas. The exact amount of recovery is not predictable at the time of injury and may be unknown for months or even years. Each brain injury and rate of recovery is unique. Recovery from a severe brain injury often involves a prolonged or life-long process of treatment and rehabilitation.

In spite of the fact that survival rates have increased with advanced trauma services and improved treatment options the impact of an acquired brain injury is widely felt by the survivor, family, caregivers, their communities, and in fact, the country as a whole.

Additional Resources:

HEALTH CARE AT HOME

http://healthcareathome.ca
Local Health Integration Networks (LHINs) provide one-stop access to health and personal support services to help individuals live independently in their homes or assist them in making the transition to a long-term care facility. They also provide information about, or link individuals to, services available in the community. Anyone can make a referral – a family member, caregiver, friend, physician or other health care professional.

ONTARIO BRAIN INJURY ASSOCIATION (OBIA)

www.obia.ca
The Ontario Brain Injury Association’s Caregiver Information Support Link (CISL) is a program, supported by the Ministry of Health, donations and other fundraising activities, to assist persons living with the effects of injury to the brain. This FREE service offers support, empowerment, advocacy and education to survivors, family members and friends. Staff can assist with issues such as rehabilitation, long-term care, housing and employment, auto insurance, disability benefits, worker’s compensation benefits, etc. Brain injury survivors and their caregivers (family, friends, etc.) are invited to become members of OBIA. This FREE membership is available after completing an annual questionnaire. The CISL questionnaire is a tool that measures an individual’s level of community integration and disability.

CANADIAN HEALTH NETWORK (CHN)

https://www.canadianhealthcarenetwork.ca/
The Canadian Health Network (CHN) is a national, bilingual health promotion program. The CHN’s goal is to help Canadians find the information they are looking for about how to stay healthy and prevent disease. The CHN does this through a unique collaboration – one of the most dynamic and comprehensive networks in the world. This network of health information providers includes the Public Health Agency of Canada, Health Canada and national and provincial/territorial non-profit organizations, as well as universities, hospitals, libraries and community organizations.

THINK FIRST NATIONAL INJURY PREVENTION FOUNDATION

https://parachute.ca/en/
The Think First Foundation provides onsite or online chapter training to hospitals and health related facilities. It offers programs to students of all ages: “Street Smart”; the “Safety Super Hero” and thought-provoking programs with VIP speakers –Voices For Injury Prevention – who explain how a traumatic injury needlessly changed their life.
Think First is your resource for educational material and resources; injury prevention programs for all grade levels; training and injury prevention involvement. Think First has joined with Safe Communities Canada, SMARTRISK, and Safe Kids Canada to create Parachute, a national, charitable organization dedicated to preventing injury and saving lives.

The content contained in this document is for general information purposes. It is not the intention to diagnose or treat a child.

Tips for Transitions from Elementary School

Transitioning your child from elementary school to junior high school or high school can be a daunting task for many parents. For the parent of a child with an intellectual disability, it can be even more difficult. You need to realize that no school is going to be “perfect”. Every parent has a different vision of what they want for their child and for their child’s education. Each child is different and their needs are different.

When looking for a junior high and/or high school, networking with other parents can be useful. You may also wish to consult with your child’s current teacher and principal. Talk to the elementary school principal prior to the Identification Placement Review Committee (IPRC).

Remember, you know your child best, but you should try to involve your child as much as possible in the decisions as this is one of the most important decisions that will affect their future.

Decide together what you both would like to see your child doing in high school while keeping the bigger picture of what they may be interested in doing after high school in mind.

The following are some suggestions you may wish to think about when looking for a junior high or high school:

Start checking out high schools 2-3 years before your child is going to graduate.

This will give you an idea of what is available and will help you decide when the time actually arrives.

Don’t limit yourself to your community high school.

Visit high schools within a reasonable distance from your home. Nowadays, many students diverge out of their community to attend the high school that will best meet their needs.

Watch for open houses at the schools; there are tours and information nights for both parents and students. If your child is not able to attend with their class, make sure they have the opportunity to go with you. Talk to your child about their impressions and feelings of this new school environment and listen carefully if they are expressing concerns or asking questions. If you can’t answer the questions, try to get the answers from the appropriate school board personnel.

Have a list of questions to ask.

Examples: What types of programs do they have? How many students in the program? Do they offer inclusive as well as segregated settings?

Have the current school set up or accompany you on a visit to the feeder school.

If you are looking to enroll in a school that is not the feeder school, the principal may not be able to facilitate the visit.

Plan your visit for first thing in the morning.

You can learn a lot about a school by the way the students enter the school. Some schools are noisy, some are calm.

When going on a school visit, take someone along.

Write down your impressions and gut feelings then discuss them with your friend. Complete writing about one school before you visit the next one.

Develop a relationship with the school you feel is the best choice.

Establish a contact person for the school.

There is the possibility of turn over in staff and funding changes.

What you saw the first time might not be in place when your child is ready to go. Keep up to date on any changes.

Ask what you can do to prepare your child for high school.

What goals can be worked on at elementary school and at home?

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Setting the Stage for Learning

Introduction

Children with ASD in Group Child Care Settings

Benefits of Inclusive Settings

Benefits of inclusive programs for typically developing children include:

Considerations in Group Settings

Physical Environment:

Space

Materials

Visual Supports

Why do visual supports make it easier for children to understand and communicate?

Preparing for Transitions

There are two main types of transitions:

Strategies to help a child make transitions:

Provide verbal warnings

Fidget Toys

Transition Objects

Music

Visual Cue

Visual Schedule

Schedule and Routine

Developing Functional Play and Adaptive Behaviour

Introduction

Developing Functional Play

1. Definition and Importance of Functional Play

2. How Children with ASD Play

3. Why Play is Difficult for Children with ASD

4. Supports for Play Needed for the Child with ASD

Teaching Adaptive Behaviours

1. Definition of Adaptive Behaviours

2. Difficulties with Adaptive Behaviours

3. How to Work with Adaptive Behaviours

4. Teaching Adaptive Behaviours

5. Problem Solving

Review

Enhancing Social Skills

Introduction

What are Social Skills?

1. Why Teach Social Skills?

2. Social Development Milestones

Social Skills of Children with ASD

Identifying Social Skills

1. Social Skills to Target for Young Children with ASD

2. More Advanced Social Skills to Target for Children with ASD

Social Skills

1. Strategies for Teaching Social Skills

Joining In

Play with Peers

Exercise: Developing Play with Peer

Visual Supports

Review

Working Together

Introduction

Who are the Team Members?

Team Members:

Family

Clinical Psychologist

Early Interventionist

Occupational Therapist

Physician

Social Worker

Speech-Language Pathologist

Other Professionals

Behavioural Therapist

Exercise: Describing Team Members’ Roles

How Does the Team Communicate?

Program Plans

Individual Family Service Plan (IFSP)

Individual Education Plan (IEP)/Individual Program Plan (IPP)

Communication Books

Parent Visits

Communicating with the Team to Meet a Challenge

Exercise: Choosing a Team Member to Consult

Read the following scenario:

Transition – Preschool to School

Review

Enabling Person-Directed Planning for AAC Users: Guidebook

Screening Tools for Information on AAC Usage

Gathering Preliminary AAC Information/Current AAC Usage

Communication Context Interview / Observation