Tuesday, 20 August 2019

"My child is so stubborn"

"My child is so stubborn", how many times have I heard that from both parents and the not so aware professional. Can a child with any kind of developmental disabilities be wantonly stubborn??

The other day, I heard this from a family member and I said, "give me an example of when he is stubborn". The reply I get is, "he can say appa but never says it when I ask him to" ??!! Did you forget the diagnosis? He's practically non-verbal. Yes, sometimes neurons fire right, sometimes they don't. Sometimes he can say a word, sometimes he can't. 

Now if you think this is bad enough, another mother tells me that the speech therapist and occupational therapist are complaining that the child has become very stubborn after the vacation and refuses to work. Excuse me! But isn't that why the child is in therapy? Because he cannot always respond like a neurotypical? How does it help if you send the child back to the mother with a "complaint"? And yes, this post is aimed more at these therapist than any parent (if it is not too beneath them to read this).

There can be many reasons why a child refuses to do what he is being asked to do. The most common reason is actually the simplest one - because he cannot to what you are asking him to do. No doubt he may have done that particular task before, but remember, the child has difficulties. He may still be in the process of learning the task. He may need you to start him off before he can take over and finish the task. He may be having an off day and cannot get the start, the sequence or the whole task. This can apply to speech, fine motor, social skills or any aspect of development.

The child with developmental difficulties is not learning speech/fine motor control/cognitive tasks in the same way as a neurotypical. He is learning it with a lot of effort, after multiple tries and very often in a different way. Only he knows what effort he has made to say "appa" or to sit at the desk and work during a session. He needs to work at it over and over again before it becomes second nature to him and for some it may never become second nature. It may remain forever hard.

Is the child any less because of it? Of course not! Unlike you, he's getting back on the horse no matter how many times he falls off. If he is stubborn, it is in a good way because he hasn't given up despite all your attempts to brow beat him into being the way you want him to be.

Another reason why the child may refuse to do an activity could be because the Individual Education Program (IEP) planned for him is totally inappropriate. You may be attempting a task that he is not ready for. Any goal that is set for a child needs to be appropriately planned for and at the appropriate developmental level of the child. You can't expect the child to do something just because it is age appropriate. He may be chronologically 4 but developmentally 2 years old. Rethink your IEP if you are persistently having difficulties getting your child to do a particular task.

Always look for reasons why a child is not doing something before concluding on "bad behaviour" as the cause. And it is okay if you don't always find an answer. There may be none.

Thursday, 8 August 2019

Understanding Therapy in Autism – IV - Encouraging Language Development

Communication is not just about getting our needs met but about sharing ideas, information and emotions. It is also about seeking information and gaining knowledge. Too often we make the mistake of sending the wrong message to our children. We constantly bombard them with questions and imperative statements demanding answers, answers they may not be able to readily give you. This kind of pressure makes the child feel like he is constantly being tested every single minute and he/she might “switch off”. Or worse still the child may try to deflect your attention by indulging in inappropriate behaviour.
There are a few simple ways in which we can change the way we communicate with the child in order to ensure that he communicates better.
1)     Talk Less - Yes, that’s right, you need to talk less. Constant jabber, jabber can be very irritating for any one, more so for a child with language difficulties. Quality in place of Quantity. You could use more non-verbal communication – pictures, voice modulation, gestures and facial expressions. Keep it interesting.
2)     Use Positive Language – Tell the child what to do and not what not to do. Nothing puts a child (or adult) off more than hearing the word “no”. And he’s likely to hear it more often if he still hasn’t learnt “appropriate” behaviours. Most children will either stop listening or will try to irritate the adult by doing exactly what they are being told not to do. Instead of saying “don’t hit”, trying saying, “hands be good” or “hands still”. Instead of saying, “don’t run”, you could say, “walk with me”. Try this with your spouses as well and see your relationship improve!
3)     Use Declarative Language – Constantly using imperative language which demands a response from the child can result in him/her clamming up. Too often the child is unable to answer. Sometimes as the child is learning to speak, he may just end up echoing your questions. He may also learn that the only purpose of language is to question and make demands. Language for the social sharing should be our final goal. Try parallel talk. Say the things that you expect the child to say. When you do this, you need to remember to drop the word, “say”. Example, “Bye aunty”, not “say bye aunty”. Do you like people constantly telling you what to say?
4)     Use One Language – In our multilingual scenario, it is important to stress on the use of a single language for the child. The same language should be used for general communication and therapy. And the same language for reading and writing. Too often, I have found parents insisting on the child learning to speak the mother tongue (which is fine) but they never teach the mother tongue for reading. They insist on reading and writing in English! And the child doesn’t understand a word of English because he has only been exposed to the mother tongue. A child with language difficulties may not be able to switch between languages and the first language he learns could very well be the only language he learns. Some children do go on to learn the second language but the first language may remain a strength.

Tuesday, 6 August 2019

Understanding Therapy in Autism -III

In the third part of our understanding therapy in autism, I will be talking about autism specific methodology. This refers to how one talks to/interacts with children on the autism spectrum. This can govern every aspect of life, all day long. Obviously this is one post that is going to stretch into several!

Several researchers and autism self-advocates have contributed considerably towards our understanding of best possible ways to interact and initiate communication among individuals on the autism spectrum. 

Three of them stand out in my mind - Eric Schopler, Gary Mesibov and Temple Grandin. The last one is an adult on the spectrum and has had a tremendous influence on the world of autism through her book "Thinking in Pictures" - a must read of people who wish to understand the spectrum better.

Eric Schopler and Gary Mesibov have been directors at Project TEACCH and are proponents of Structured Teaching. While Project TEACCH has never made waves like ABA (Applied Behavioural Analysis), it nevertheless has been around for a long time (from 1966). Several of the principles suggested by then have now been incorporated by many other methods.

I would like to dedicate this first post to the fact that most individuals on the autism spectrum are visual.

Visual supports, to the best of my knowledge, were suggested by Project TEACCH. Visual supports received much attention after Temple Grandin's "Thinking in Pictures" was published.

Individuals on the autism spectrum are visual learners. They understand what they see far better than what they hear. This applies even to the very verbal ones. Saying that the individual can now understand spoken language is just no excuse to stop visuals. Yet, this is commonly done both by parents and many professionals.

Visuals can be used in the form of picture cards to communicate, to make a schedule or to relate a social story. Visuals should not be confused with videos. Visuals are static and convey the point much better to a child on the spectrum than dynamic videos. Visuals can be line drawings, pictures or photographs.

Visual supports help:

  1. Provide predictability and thereby reduce anxiety
  2. Provide clarity to the individual
  3. Help the individual understand the sequence
  4. Reduce stress for both parent and individual
  5. Help teach language
  6. Help jog the memory 

First & Then Cards

This consists of 2 pictures in a sequence which tells the individual what he will do first and what next. This can be used to provide clarity and also to help manage difficult behaviours. By putting a preferred activity after an activity that is disliked, we can help ensure that the disliked activity is carried out. 

First eat


Then go outside


Visual Schedules

This is a pictorial schedule that tells the individual what is going to happen through the day or a part of the day. It makes the routine predictable and also helps the individual organize the sequence in which the tasks should be carried out. This can be used to indicate all the activities that the individual has to do at his workstation or it can be used to indicate his daily routine. This can also be used to indicate part of his day's routine.



 Go to school

Behaviour Support Cards
These cards are pictorial representations of expected behaviour. These can be flashed when communicating with the child, reinforcing the spoken word. For example, flash a picture of a child sitting on a chair, to indicate that you would like him to remain seated.

Image credits: www.do2learn.com