My son was diagnosed with Autism at the age of 2 years and 3 months. A month later he was on intensive one-on-one home-based therapy. By five, he was in a regular mainstream school, totally indistinguishable from his peers.
I soon found there was very little software available to teach children with Autism. This document outlines the information on Autism I have acquired over the years and the computer software I used to aid my son's recovery.
It is important to understand that without any Autism therapy or intervention, a child with Autism or PDD will absorb far less information and knowledge from the environment than a typical child. A typical child will start to talk at 1.5 to 2 years with almost no help from his parents or siblings. He will then acquire around 6 new words a day and will have a vocabulary of an amazing 10,000 words before the age of seven. A child with Autism may become verbal much later and have poor language and social skills if he is not given speech and behavior therapy. At least initially, a child with Autism must be given a strong knowledge base i.e. he must be taught speech, language and age-appropriate behavior.
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Starting work with your child
If you even suspect your child has Autism or ASD, you must begin work with him immediately. Do not waste vital time waiting for a formal Autism diagnosis. I met one mother who waited six months for a formal Autism diagnosis before beginning any treatment. Imagine how much she could have taught her child in that time. You will find out for yourself that most doctors know very little about Autism and will simply recommend speech therapy, special education or an early intervention center. The worst thing some doctors will do to a parent is to take away hope. You will acquire more information on Autism from other parents of children with Autism than you would from any general practitioner. As you work with your child and see the results, you will soon find other parents of newly-diagnosed children with Autism coming to you for advice. Start working with your child now, even if it means just trying to communicate with him through play. This time will never ever be wasted. Even if tests show that your child does not have an Autistic disorder, you've lost nothing. Trying to teach a child with Autism at the table could be difficult at first, as the child may resist learning and lots of positive reinforcement and encouragement is vital. There are many structured teaching methods for children with Autism such as ABA, TEACCH and Greenspan to name a few. Many parents adopt their own, often very successful strategies for teaching their children at home.
Many parents will simply not believe their child has an Autistic disorder and will not even seek a diagnosis. Too often, they ignore the clear signs of Autism in their child and somehow hope he will improve on his own. They often wait until it is too late to start work with their child. Some of the excuses I've heard are: "He looks fine - it's just the terrible twos", "My son started talking at five", "Einstein had Autism and he started talking at nine", "He'll just grow out of it" (and the list goes on...).
Although an early Autism or ASD diagnosis for this potentially devastating disorder is critical, children with Autism rarely receive a diagnosis before the age of 3 or 4 years. There are no outward physical differences between Autistic kids and typical children - in fact most children with Autism are very good-looking. The only differences are behavioral. Autistic kids will exhibit at least some of the following:
Poor speech and language skills
Inappropriate play eg. child may continuously spin the wheels of a toy car rather than push it
May line up toys or other objects
Trouble interacting with others
Poor eye contact
Walking on toes
Tendency to have narrowly focused and odd interests
Not asking for things in the same way as other children
Failure to show objects to others
Failure to orient to one's name being called
Failure to engage in reciprocal play where there is a back-and-forth between two people
Failure to copy others' motor movements
May not use pointing to direct another person's attention
May resist social touch such as hugging
A child with Autism can be anywhere in the broad Autism 'spectrum'. At the upper end, the child could appear almost normal and have few autistic traits. He may perhaps be the quiet child in the classroom with few or no friends and a couple of quirky habits. He may not even be diagnosed having Autism until much later in life. At the lower end of the Autism spectrum, the child would be termed low-functioning, have poor speech and language and would require much more intensive Autism therapy. No matter where a child is in the Autism spectrum, he can and must be helped.
PDD NOS and Autism
Pervasive Developmental Disorder or PDD is actually a bit of a misnomer. Many doctors who would not like to commit to giving a diagnosis of Autism will tell the parents that their child has PDD or PDD NOS when in fact the child is in the Autism or ASD spectrum.
Types of Autism
Some children are born with Autism while others develop the condition usually in their second year. The latter is known as late-onset Autism. The child starts life normally and gradually develops the symptoms of Autism, losing speech and gradually showing more and more of the symptoms if Autism. If diagnosed and treated early with one-on-one therapy, Autistic children will show remarkable improvement, often to the point of being termed "recovered". This is where the child with Autism is indistinguishable from his peers.
Asperger's disorder and Autism
Asperger's disorder, also called Asperger's syndrome is a type of pervasive developmental disorder (PDD or PDD NOS) as defined by the American Psychiatric Association. Asperger's disorder is similar to high-functioning Autism in how it affects a child's mannerisms and socialization traits. A distinction between Asperger's syndrome and Autism is that young children with Asperger's often have normal language development, although the rhythm, pitch, and emphasis are irregular. Unlike Autism, Asperger's disorder does not delay other aspects of development; a child usually has age-appropriate self-reliance and an interest in the world around him or her. However, like Autism, children with Asperger's syndrome have abnormal social interactions, facial expressions, and gestures. Asperger's disorder affects males 9 times more than females. Its cause is unknown. More research is needed to confirm whether Asperger's disorder is a condition that is genetically related to Autism.
Autism Therapy and Speech therapy
Speech therapy certainly has it's place in prompting and refining a child's speech and vocalization but it takes many hours a week of intensive one-on-one work to teach the child with Autism compliance, new concepts, language and age-appropriate behavior. A child with Autism will typically see a speech therapist for 1 or 2 hours a week. Once your child is in school, it would be wise to continue the speech therapy sessions. Some schools have a speech therapist that works with the children at the school itself. More on Autism and schools later.
Language is the key
The frustration of a child with Autism was once described as that of being in a maze where the walls are made of glass, trying to communicate with someone on the outside and only being able to bang on the walls. There is no doubt that much frustration and temper tantrums can be reduced and even avoided when communication and language is encouraged and developed. A typical child works out very early that it is in his own interest to acquire language whilst a child with Autism may not. He needs to be taught that language will get him results. On this point, if your child asks for something, give it to him immediately or at least respond to his request immediately. Ignoring him will certainly not encourage his speech.
When do I start to treat a child with Autism?
If a child has Autism, the clock has already started to tick even before any formal diagnosis. The most gains will be made when the child is in his very early years. Although children as young as 18 months are on Autism therapy, most are diagnosed after 2 years of age and start treatment even later. Whatever you do, don't leave it until it's too late. Quite simply, the sooner you start teaching a child with Autism the better.
Of all the therapies around for Autism, ABA (Applied Behavior Analysis) has attracted the most attention. The system pioneered by Dr. Ivar Lovaas at UCLA in the sixties is a teaching program that works on systematically removing the "traits" of Autism until the child does not satisfy the criteria for the condition. The system is very intensive but proven to be extremely successful in almost all cases of Autism. The Applied Behavior Analysis teaching system basically breaks down any task into subtasks and places a very high emphasis on rewarding the child for working well. There is no physical punishment at all in the system. Autism therapy starts off in a very rigid structured form but gradually takes the shape of a typical school environment. Those who know little or nothing about ABA may say it is too rigid and turns the child into a 'robot' by rote learning. This would appear so at the start but as the child learns to learn, he progresses to a point where he can join his typical peers in their learning style. Most parents who persevere with the program for two to three years can successfully mainstream their children. The results speak for themselves. The child usually begins school, attending regular classes with an aide. The aide is gradually 'faded' and the child blends in with the class. More on aides and fading later.
How many hours?
A question often asked is how many hours of behavioral therapy does a child with Autism need? There are many cases where a child with Autism needs up to 40 hours a week but of course, it depends on the level of severity of the child. A program usually starts with around 15 to 20 hours a week and can work towards 30 or more hours a week. Once a child with Autism is in school, the hours of work at home will fall back. Quality is of course, more important than quantity and energetic, dedicated therapists are vital to your child's progress.
Working with your child
I would strongly suggest the parents begin working with the child at least initially rather than leaving him to a therapist. Your child will trust you and understand you are trying to help him. You need to have boundless energy, be animated and genuinely love teaching your child. This is not easy and experts estimate you could do this for no more than 10 to 12 hours a week. If both parents take turns, the task is, of course a lot easier. Later, you could introduce a therapist or two to help out as you will not be able to maintain a high level of energy for too long. An advantage of doing the initial work yourself is that you will then know a good therapist when you see one and be able to weed out those that are of little value to your child.
Choosing a therapist
Choosing a good therapist for a child with Autism is not easy if you haven't worked with a child yourself. Many experienced parents will actually be able to train their new therapists. Therapists can be anyone with enough energy, enthusiasm, patience and genuine love for children. Those below the age of 18 are often too young and immature (some will actually be frightened!). Mothers with children often don't have the time and energy and often don't like to be told how to deal with children as they feel they are the experts. One applicant told me how she regularly smacked her own children when they misbehaved. There is no room for such people in your home. A good tip is to make a short list of the ones you feel may be suitable and tell them there will be a training period of a couple of weeks during which there will be no payment. Many of them will drop out as working with a child with Autism is very demanding and not suited to everyone.
Whilst there are many excellent special education schools around, sadly, many are under-funded, understaffed and ill-equipped to teach children with Autism. There is usually not enough one-on-one support for the child and worst of all, the child can pick up inappropriate behaviors from the other Autistic children. I find all this heart-breaking as there is so much a child with Autism can learn in the critical early years.
Your goal should be to get your child into a mainstream school. Three years of intensive one-on-one work at home will go a long, long way towards successfully mainstreaming a child. Once a child with Autism is successfully mainstreamed you have won half the battle. I say this because it would be wise to continue working with him at home as well. You may need to educate the principal and staff on Autism and a good idea is for you or your therapist or consultant (if you have one) to do a short presentation. I would strongly advise liaising with your child's teachers to address any difficulties at school. You could use this feedback to work with him at home thus preventing him from falling behind. Obtaining in advance his school books and material they are going to cover at school is a good idea as you could work with these at home, reading them to him at night etc. so it is not all new to him at school. It is advisable to keep his home therapists as his school aides as they will know him a lot better than any school-provided aide. You need to discuss this with the school principal before he enters school. Once he enters school, you may need to begin with short hours eg. 2-3 hours a day and gradually build up to a full day.
A child with Autism often has uneven skills eg. he may have very strong areas such as memorizing pictures or words and reading at an early age and weak areas such as making social contact with his peers. You need to firstly identify the strong areas. It goes without saying that you should use these strengths to the fullest advantage. For example if the child has strong reading skills, explore this to the maximum. Many of children with Autism have very strong visual skills. Use pictures to stimulate and refine their language. If your child learns to read or write before he gets to school, it will be one less thing to worry about and he will have more time to learn other skills that he is lacking.
"My child can't talk at all! Where do I start?"
A frantic mother of a child with Autism once phoned me with this question. Teaching speech to a child with Autism is done on a step-by-step basis. A child cannot run before he can walk. Before attempting actual speech, you can first teach a child to match identical pictures, then non-identical pictures i.e. matching a red car with a different-colored one. The next step is receptive language where the child is asked for the picture of eg. a cat, horse, house etc. (see next section). If your child can achieve receptive language or has already reached this stage, this is promising as he can at least understand what you are saying and this will ultimately lead to him expressing himself verbally. Do not be complacent though, as his vocabulary may be limited. You must do what you can to make sure his vocabulary is expanded as widely as possible.
This is where the child understands what other people are saying. It is a major step in the progress of a child with Autism. It is however not enough for the child to understand just a handful of words such as food, milk, bike etc. A typical child of seven can understand and use at least 10,000 words. A child with Autism needs to have his receptive language boosted as early and as quickly as possible.
Receptive language software
The Discrete Trial Trainer is a software package that allows you to use your computer to teach your child any number of labels and sounds. What happens is the screen displays from 2 to 5 images and the child is asked over the speakers eg. "Touch Eating". If the child correctly clicks on the correct image using the mouse or touch-screen, he is rewarded with a little animation. When one label is mastered, the program moves on to the next label, occasionally bringing in mastered labels to see if the child has remembered them. This CD has been extremely successful. You can set the level of difficulty and you get a visual report of his progress. With this package you can use it to teach categories as letters, words, shapes, numbers, colors, objects, body parts, actions/verbs.
Teaching with pictures
"A picture is worth a thousand words" and using pictures is an excellent way to teach speech, language and communication. Children with Autism are highly visual and can be taught almost anything using images. Temple Grandin, the famous autistic author of many books on Autism once said that she thinks in pictures. You need thousands of good photographic pictures to help with 'generalization' i.e. if a child with Autism has just one picture of a white dog and is taught this is a dog, he may not easily recognize a German Shepherd or a Rottweiler as a dog when he sees it. Using new and varied material also keeps a child from getting bored and frustrated. Minimize the number of stick images or drawings used. Actual color photographic material is best as the images are more life-like and much easier for the child to relate to. You can never have too many pictures in your collection. Get them from anywhere you can - magazines, old books, the web, printed catalogs, even junk mail!
Printing from a CD-ROM or USB
The falling prices of computers and color printers has created a trend away from buying expensive printed flashcards towards software such as our New Flash! Pro3 (now on USB) that contains over 15,000 color photographic teaching images that can be printed from a home PC to a color printer at a tiny fraction of the cost. You can pay up to a dollar for each printed flashcard, whilst printing from our Flash! Pro3 works out to around 1 cent per picture. Another advantage of using this software is the huge range of pictures is that you can select and print what you need at any time. You do not need to print all the pictures right away. The images on the Flash! Pro3 can have their labels switched on or off. You can print the images in sizes varying from 1 per page (biggest) to 8 per page (smallest). This product with over 15,000 printable teaching images is our most popular product and is widely used to teach children around the world. The images can be used in any teaching system such as ABA including working with Matching, Receptive language and Expressive language.
Modern color printers are not only a lot cheaper than they were just a few years ago, they can also print photographic-quality prints onto ordinary (photocopy) paper and don't require special expensive paper. If you are printing thousands of pictures to use as flashcards, you may not want to print them on special paper. You need to be able to print photo-quality pictures to regular photocopy paper. If you already have a printer that needs special paper and you want to print thousands of pictures, it could be worth looking at getting a new printer. The new inkjet printers produce high quality text and images in black and white or color. Many of today's inkjet or bubblejet printers can print photographic images and laser-like text that come close enough to the quality of more expensive laser printers. I personally use a Canon inkjet although there are many other good-quality, yet low-priced models around.
Printing in draft mode
Try printing in draft mode. If the quality is almost as good as in best mode, it may be worth your while printing in this mode as the prints will not only be faster but also cheaper as they will consume less ink.
Laminating your pictures
Laminating your pictures will give them a much longer life. If you are going to laminate a lot of pictures, a good idea is to firstly buy a good laminator. If you are going to insert more than one picture per laminating pouch, insert your trimmed pictures into the laminating pouch with a space between each picture for trimming around later. After running the pouch through the laminator, cut between the cards. Don't forget to round off the sharp corners that could easily injure someone. The laminating pouches we recommend are 120 microns or (sturdier) 150 microns in thickness. A good idea is to insert 4 trimmed pictures per letter-sized (or A4) laminating pouch. Pouches can be bought in packs of a hundred.
Using your own pictures
It is always an excellent idea to include your own pictures taken of the child's environment, family members, familiar locations, occasions, school, classroom, school friends etc. to teach you child. Using a conventional camera (with film) is OK but taking many hundreds of pictures is not only expensive but you cannot easily resize the pictures, add labels to the pictures or include them easily into other electronic documents you may wish to create. The advent of the digital camera allows you to take an unlimited number of pictures that you can download onto your computer. Once the pictures are downloaded, the camera is reset and you can take the next batch. A great feature of the Flash! Pro3 is that you can also view, resize and print your own digital camera images to use as flashcards.
Organizing your cards
It is important to organize your cards or you will waste vital time looking for them when you need them. My suggestion for the size of flashcards to be used for teaching purposes is to keep a standard of 4 per letter-sized (or A4) page - much bigger and you'll find it hard to file away the pictures. A good idea is to get a set of (preferably long) card cabinets to file the cards in their different categories eg. animals, actions, food, vehicles, plants etc. The cabinets we recommend are around 16in (42cm) long and can each hold at least 200 laminated flashcards. Take a laminated picture card with you for size when looking for cabinets. A good place to find cabinets is a used office furniture and equipment store. I use one cabinet drawer per category. You can cut cards with name tabs so they stand out above the cards to subdivide the categories eg. for animals - cat, dog, chicken etc.
Rotating your material
Once a noun, verb or concept has been mastered by your child, you must rotate your material i.e. don't use the same picture over and over again as this can be very frustrating for a child with Autism (another good reason to keep a big collection of images). A good idea to ensure your images are rotated is to "select from front and return to back" i.e. if you have 8 pictures of a cat, then choose the one from the front of the set and when you're done with it, return it to the back of the set. This way your pictures will be used evenly.
Many children with Autism have difficulties processing sound or distinguishing noise from normal conversation. Hence, they often appear deaf although they have normal hearing. Typical children are able to "filter" out background noise from useful auditory information. Children with Autism very often attempt to block out this bombardment of sound and retreat into their own world. In many cases they will hold their ears. In some cases, they will rock to and fro in an attempt to block out the sensory overload. It is important to teach these children to identify sounds. This goes a long way in being able to sort out noise from useful auditory information such as a teacher's instructions, a parent's voice, traffic, a barking dog etc. Some sounds you can teach your child to identify are:
Airplane, Ambulance, Baby crying, Bagpipes, Bath tap, Bee, Bell, Bicycle bell, Blowing nose, Brushing teeth, Cannonfire, Cat, Chick, Chicken, Children playing, Chopping, Church bell, Clapping, Clock ticking, Coughing, Cow, Cricket, Crow, Crying baby, Crying child, Cymbals, Dentist drill, Dog, Dolphin, Puppy, Drill, Drum, Duck, Rubber Ducky, Biting apple, Elephant trumpet, Fan, Fire, Fire alarm, Fire truck, Fireworks, Flushing toilet, Flute, Food blender, Frog, Goat, Goose, Gunshots, Guitar, Hair dryer, Hammering nail, Harp, Helicopter, Horse neighing, Horse galloping, Jet, Keyboard of PC, Kissing, Kitten, Knocking on door, Laughing, Lightning, Lion, Monkey, Motorcycle, Mouse, Mowing lawn, Ocean, Opening coke bottle, Owl, Parrot, Peacock, Piano, Pig, Pinball machine, Police car, Pouring, Power drill, Railway crossing, Rooster crowing, Sawing wood, Scissors, Seagull, Sea lion, Sheep, Shower, Sneezing, Snooker table, Stirring tea in cup, Tambourine, Tap dancing, Running, Tearing paper, Telephone, Tractor, Train, Truck, Trumpet, Turkey, Vacuum cleaner, Yawning. These sounds are now included on the new Flash! Pro3 USB together with their corresponding images.
Autism is a sensory condition affecting one or more of the child's senses:
Touch: A child with Autism could be very sensitive to touch and may resist close contact, hugging etc. even from even his parents.
Sound: Certain sounds could be unbearable to an autistic child. He may even hold his ears when hearing some voices or sounds. Some children with extreme sound sensitivity will respond better if the teacher talks to them in a low whisper.
Taste: Certain food textures could be unpalatable to a child with Autism. Some children will only eat a select few foods.
Sight: One autistic adult stated that he could not stand to look at the color yellow.
Smell: Some children may show a strong preference for certain, often unusual odors.
You should bear this in mind when setting up your child's learning environment and be prepared to make any adjustments.
A child with Autism should begin work in a quiet environment without any distractions. However, the real world is not so sterile. A classroom of kids can be very noisy. You should thus slowly introduce "noise" into your child's teaching environment. One way is to start with the doors and windows closed and over a period of time, gradually open the doors and windows. You could also introduce very soft music, turning the sound up very gradually over the weeks. If you find your child cannot concentrate, reduce the noise levels and start again gradually.
Working at the table
Working and concentrating at the table for a child with Autism will not be easy especially at the start. Keep the sessions very short to begin with. It is always tempting to keep going when the child is doing well. But this will backfire if you keep the child working at a drill for too long. You will know this when the child does not want to begin the next drill as he will show a lot of protest behavior. Always move up gradually. Never reward a child who is working well with more work. If you feel he has done particularly well at a drill, let him go for a short break to do whatever he wants. He will soon make the connection between good work and rewards. There may be times when you let him go for a break just for coming to the table with no protest at all.
Finishing on a positive note
When you begin a set of drills with your child, you must always finish on a positive note. If you end a drill when the child has a tantrum, this will simply tell him he can end his work with a tantrum. A tantrum could mean that the drill is too long, too difficult or even frustratingly easy or boring. There may be times when the child will simply not finish a drill. If this happens, get him to do something a lot easier to finish off eg. "Clap your hands" (he claps) "OK, good boy, off you go". This principle applies to all aspects of the child's daily routine and activities. For example, if he tantrums to brush his teeth and you allow him to leave the bathroom whilst he is yelling, he soon learns that the best way to get out of brushing his teeth is to throw a tantrum. The only way is to ignore the tantrum (can be very difficult) and continue with the task at hand or at least until the tantrum has subsided. Letting him go then, will teach him he gets rewarded for good behavior or finishing the task.
You must set aside a room to do your work and store your equipment such as toys, books, pictures, cards, videos etc. You will soon build up a huge volume of items that must be available when you need them. A good shelving system to hold your books, videotapes and lots of good-sized stackable drawers for your cards, pictures and toys is a good idea. If you child has outgrown his toys, put them away in the garage. Some toys that have lost their reinforcing value could be brought back at a later stage. For a child with Autism, appropriate play with toys is always a plus. Don't hold back on getting him new toys. Joining a toy library is a good idea to save money. Another idea is networking with other parents and exchanging toys with them.
Reading is of course a vital skill without which a child cannot get very far in school or society. A common mistake is to teach reading using just words without pictures or any other media. The child could learn to sight-read by memorizing the sequence of letters but may not understand much of what he is reading. A much better approach is to begin by using pictures with the text underneath. The child will then associate the words with the pictures. Do not teach your child to read words he would not know the meaning of. The Flash! Pro3 mentioned above is a ready source of images that can be printed with or without the labels to teach sight-reading.
Click here for the video of the list of phonics sounds. Most educators do not use the child's visual strengths to complement this method of reading. Using images makes the task a lot more interesting and of course, relevant. Once again, do not teach your child to read words he would not know the meaning of. You must document what your child can read. Once you are confident he knows the meaning of a word, annotate this word as "mastered".
Use the TV as a teaching tool
My son learned his alphabet from Sesame Street before he was three. He loves watching movies. I use this to an advantage by allowing him to watch DVDs with the subtitles turned on. Without a doubt, this has contributed to his reading skills.
When testing your child's spelling, don't simply say eg. "Spell cat". Try and get him to work out the word you want by saying eg. "What animal goes miaow and drinks milk". When he says "Cat", you say "Great, spell cat". This will help him build the connections in the mind that all developing children need. Be imaginative and use different clues each time.
Knowing when to move on
Once your child has mastered an exercise (be it understanding of a word, concept, spelling, reading or whatever) you must move on or he will get bored and frustrated and this could manifest itself in bad behavior. A good rule of thumb is if the child gets the exercise correct 8 times out of 10, consider it mastered. Move on to the next piece of material but do the mastered exercise twice a week for two weeks, then once a week for a month, then once a fortnight for two months and then once a month for four months. The exercise is then truly mastered. Of course you could be running several different programs on any given day. Working with your child will teach you to challenge your child but not to the point where the demands are too high. A good consultant to monitor your teaching schedule is well worth considering.
What does a consultant do?
At the start, a consultant will establish a baseline i.e. establish where the child is at developmentally and accordingly draw up a teaching program to be followed on a daily basis. Ideally you should see your consultant once a week. On a weekly basis, a good consultant will work intensively with your child for around two hours while you watch very carefully - you will need to do the same work over the following week. After working with the child, the consultant will speak to the parents and decide on the work to be done in the following week. With our son, we kept a live spreadsheet document of the work we did over the week. When the consultant came in, she could look at the printout and see at a glance how he fared over the week. At the end of the meeting, she would amend the sheet to include any new programs. A consultant will let you know what programs to begin, continue with and drop.
With several different drills in your child's schedule, you must have some sort of recording system. Keeping a record of a child's drills and progress is very important. If this is not done, you run the risk of not remembering what the child has learned. You will frustrate the child by using materials repetitively and worst of all you could drop material from a drill before it has been mastered. A simple but very effective way is to record the child's progress on a spreadsheet such as Excel. Keeping a track of pictures, words etc. that are Mastered, Current and Next, gives you an easy way of rotating your material so the child doesn't get bored with mastered items, keeps him focused on current material and allows you time to work on obtaining new items and ideas that can be added to the list. The entire schedule can be held on a single file with each program on a different worksheet within the file.
Most frequently used words
The complete Webster's dictionary has over 460,000 words. However, around 75% of all words used in schoolbooks, library books, newspapers, and magazines are in the Dolch Basic Sight Vocabulary of just 220 words! These words are: a, about, after, again, all, always, am, an, and, any, are, around, as, ask, at, ate, away, be, because, been, before, best, better, big, black, blue, both, bring, brown, but, buy, by, call, came, can, carry, clean, cold, come, could, cut, did, do, does, done, down, draw, drink, eat, eight, every, fall, far, fast, find, first, five, fly, for, found, four, from, full, funny, gave, get, give, go, goes, going, good, got, green, grow, had, has, have, he, help, her, here, him, his, hold, hot, how, hurt, I, if, in, into, is, it, its, jump, just, keep, kind, know, laugh, let, light, like, little, live, long, look, made, make, many, may, me, much, must, my, myself, never, new, no, not, now, of, off, old, on, once, one, only, open, or, our, out, over, own, pick, play, please, pretty, pull, put, ran, read, red, ride, right, round, run, said, saw, say, see, seven, shall, she, show, sing, sit, six, sleep, small, so, some, soon, start, stop, take, tell, ten, thank, that, the, their, them, then, there, these, they, think, this, those, three, to, today, together, too, try, two, under, up, upon, us, use, very, walk, want, warm, was, wash, we, well, went, were, what, when, where, which, white, who, why, will, wish, with, work, would, write, yellow, yes, you, your.
Keep these words handy and teach them to your child as soon as possible. Have pictures put up on your wall or notice board with the labels below them. When your child starts reading, this list should be kept handy. Some concepts such as "think" and "wish" will come after simpler items such as "jump" and "drink" but hey, Rome wasn't built in a day! An excellent source of words is from the Ladybird book series called "Key Words Reading Scheme" which is a set of little children's storybooks organized very cleverly to include the 1,200 most-used words in the English language. These well-illustrated books gradually build the child's language.
My own list
I have loaded up a list of over 2600 words from my spreadsheet (click above on the "Vocabulary" tab to view this list). You can highlight the entire list, copy and paste the list into a spreadsheet (I suggest Excel). You can, of course edit this list, deleting whatever you don't want and adding new words etc. You can use the list in many ways. I used the next columns to date when a word was a) first read b) last read and c) last spelled. The next columns were used to count the days the currently worked-on words were successfully read/spelled. This was to indicate when a word was marked as mastered in reading or spelling. Once you have this live document, you can sort it by date to rotate you mastered reading and spelling words to ensure the child has not lost what he has learned. If he has lost a word eg. in reading, this word must go back as a current word and repeated in the daily drills eight days in a row correctly to be remastered. I use ten current reading words and ten current spelling words on any day. Yes, it's a lot of work but if you don't document your child's work, you run the risk of him losing words and ultimately having a very limited vocabulary. It is not unusual to come across an untreated child with Autism in his teens with a vocabulary of less than 200 words.
Hitting a brick wall
Some educators will tell you that you will ultimately hit a brick wall i.e. you won't be able to go past a certain point when teaching an autistic child. Do not believe this. We were told our child would not be able to read beyond the standard 200 words. By 6 years he could read and understand over 1,000 words and spell over 400 with his vocabulary increasing with each day. When you come to a brick wall, don't break you head against it. Find a way around it! Also, don't believe everything the doctors tell you. You will find out for yourself what strengths and weaknesses your child has as you work with him.
Using the computer as a teaching tool
Children with Autism are usually very strong visual learners and can benefit enormously from a home computer. However, there is a lot of over-priced and over-rated software out there with very little reinforcement and limited educational value. The best software allows you to edit information and enter new teaching material and reinforcement. Reinforcement is vital (and severely lacking in most learning software packages) to hold the child's interest and involvement. The software must also be easy to use - easy enough for a parent to operate and edit and of course if the child is to run the software, it should be easy for him to do so. Our son has almost 150 CD-ROMs in his software collection. I am always on the lookout for new software to interest him.
At least 50% of children with Autism respond to dietary intervention. The main culprits are casein (found in dairy products) and gluten (found in wheat, barley, rye and oats). Many research scientists indicate that incompletely digested gluten and/or casein enters the bloodstream and plays havoc with the child's system, affecting brain function and learning processes. Many parents observe that casein and gluten foods make their children vague, sluggish and spacey. Others say these foods trigger episodes of extreme aggression or self-harm. Dr. Kalle Reichelt is a is a noted scientist who has written extensively on this topic. It is extremely difficult to maintain a GFCF (gluten-free, casein-free) diet, however it is possible and many parents claim excellent results. There is a good book called "Special diets for special kids", written by Lisa Lewis that includes GFCF recipes.
Recent studies are showing that Vitamin E reduces oxidative stress and may be able to protect against chemical damage that may cause Autism. Excellent natural sources of vitamin E are raw sunflower seeds, almonds, olives, papaya, turnips and spinach.
New studies are showing that digestive enzymes particularly DPP-4 break down gluten and casein. Many parents have found that enzymes allow them to take their children off the gluten-free/casein-free diet without triggering off side effects or behavioral regressions.
An attempt to condition a "leaky gut" could be by giving the child DMSO or MSM, the latter of which is apparently harmless even in large quantities. If you suspect a child has leaky gut or irritable bowel syndrome, instead of trying to avoid gluten and casein, my suggestion would be to attack the source of the problem by repairing and conditioning the gut lining. Apparently MSM can help in this area. I have put this suggestion to a few notable scientists but was met with scepticism. MSM or Methylsulfonylmethane is a non-toxic substance, with a toxicity profile similar to that of water. The body uses the MSM that it needs and eliminates any excess within 12 hours. MSM should not be confused with sulfites or sulfa drugs. Allergies to these substances do not affect your ability to take MSM. Although MSM is found in the tissues of all plants and animals it is difficult to obtain sufficient amounts without supplementation. MSM is stored virtually in every cell of the body. It is important to take MSM free of any additives. Read the label. Avoid unwanted ingredients such as Dicalcium Phosphate, Gelatin, Magnesium Stearate, Silica and Stearic Acid. Also avoid MSM that is produced in countries where the water may not be of the best quality as water is used in its manufacturing process. MSM powder may be added to any hot or cold beverage or even mixed in oatmeal or other foods. Many children with Autism have bowel problems such as constipation or diarrhea. It may be worth trying MSM in these cases to at least try and alleviate the bowel problem. It can be purchased from any pharmacy. Before giving your child any medication, please consult your doctor. There is a book called "The Miracle of MSM" for those who wish to pursue more information in this area.
There is as yet no drug that cures the core symptoms of Autism but some can ease the behavioral problems. Antidepressants such as Prozac may reduce repetitive behaviors. Stimulants such as Ritalin may lessen hyperactivity. Anti-psychotic drugs can decrease aggression and hyperactivity. Beware of side-effects though. Recent studies have shown kids on Ritalin could suffer side-effects from hair loss to heart attacks. Risperdal is used to treat irritability associated with autistic disorder, including temper tantrums, deliberate self-injury and aggression in children and adolescents, ages 5 to 16. The approval is the first for the use of a drug to treat behaviors associated with Autism in children. Risperdal, first approved by the FDA in 1993, has been used to treat schizophrenia and bipolar disorder in adults. The anti-psychotic drug is not a cure for Autism, nor does it treat the condition itself, but it may provide relief for some children.
Regardless of whether you use diet intervention, enzymes, drugs or other medication, none of these is a substitute for early teaching intervention i.e. you must keep teaching your child, using this window of opportunity to his best advantage. No other intervention alone has yet proven as successful.
Many people believe that children with Autism have high levels of mercury and other heavy metals (often introduced into their system by vaccines). A harmless way to find out if your child has indeed heavy metals is to send a hair sample for analysis to a reputable lab.
There has been much debate about vaccines, particularly the MMR vaccine causing Autism. The MMR is a triple vaccine (mumps, measles and rubella) given as a single combined injection. An excellent book that discusses possible causes and treatments is "Biological Treatments for Autism and PDD" by William Shaw Ph.D. Note that whatever biological treatment steps you take to treat a child with Autism, you simply must continue with behavioral therapy or his progress will be slow.
All children benefit from physical exercise. Children with Autism have shown remarkable improvement with vigorous exercise especially with concentration and alertness. Daily Life Therapy developed by the late Dr. Kiyo Kitahara of Tokyo, Japan puts a strong emphasis on systematic education through group dynamics, the intermingling of academics and technology, art, music and vigorous physical education. The Boston Higashi School applies the Daily Life Therapy. It is now famous in the US for its high success rate in helping children with Autism. It is true that a healthy mind will exist in a healthy body. You will have to improvise when teaching your child to play and exercise. As an example, if you feel your child is not ready for badminton, try getting him to play hitting a balloon instead of a shuttlecock. This is an excellent exercise to help with a child's coordination and can be a precursor to badminton or tennis.
It was once believed that children with Autism could not receive and/or process auditory information. This was because many of the children appeared deaf. It was proven only relatively recently that the reverse is actually the case. Typical children can filter out background noise and selectively listen to speech and relevant sound. Children with Autism cannot easily filter out background noise. Hence someone talking to them may as well be the sound of a car driving past. Understandably, the huge amount of auditory stimulus can easily overload a child with Autism. In some cases, the child with attempt to block out the stimulus by holding his ears or by rocking to and fro. The best way to calm down a child with Autism is to lower the noise and other stimulus levels right down. Bright flashing colors could also be distressing to him. As mentioned before, Autism is a sensory malfunction and all five senses could cause problems in a child with the condition.
Getting enough sleep is very important to a child with Autism as the stimulus load on him through the day will be much greater than on a typical child.
Stimulatory behavior or 'stims' are when the child will do something repetitively such as flapping his hands or running to and fro. A stim is usually a coping mechanism for the child when he is under stress or when he needs to unwind eg. when he comes home from school. A little stimming should be tolerated by the parents. Getting him interested in something else is the ideal way of avoiding this behavior.
This is when the child will repeat (often repetitively) what he hears without necessarily understanding what he is saying. Although this is not the best behavior, the child can at least vocalize words and can be taught speech and language. You could use this to the fullest advantage by getting your child to express a variety of words that will come into use in his following years. Better still, show him a picture of what you are saying before saying it.
The child may babble repetitively about a number of things such as his favourite TV show or movie. Many experts will say to stop all babbling in your child. I would not agree entirely with this for the simple reason that even typical children babble as a precursor to speech usually at around 1.5 years of age. Children with Autism will begin speech later and will start at that stage by babbling. All you need to do is establish with him when this is OK (eg. when he is at home) and when it is not i.e. in public.
He needs to be taught awareness of others' reactions to his verbal stim. You need to work on him doing this quietly or nonverbally. You can actually expand on what he is stimming about through conversation, drawing and role-playing in an attempt to convert this stim into a learning process.
All children need a break from work. Consider this excerpt from the Woman's Weekly: "Short, intense bursts of excitement can actually make you more resilient and able to cope better with prolonged stress and tension. Have a day off work and organize to spend it doing something you've always wanted to do - but make it a challenge that makes you just a little bit nervous, something that expands your boundaries! Book a flight in a hot-air balloon, go on a roller-coaster ride or a parachute jump, or plan a day at the races with friends. Learn how to rally-drive, or go on an ocean trip where you can see whales and dolphins. Taking time out to do something new, exciting and a little bit scary can set off the biological fight-or-flight response, flooding the body with stress hormones. But once the ride or jump is over, the hormonal changes are rapidly reversed and anxiety is replaced by elation. Research from the University of Nebraska confirms this idea, showing that the 'rush' you get from intermittent physiological arousal resulting in a short-term stress response can be as effective in beating stress as repeated exercise." The same would apply for all children, so let them have their adrenalin rush and avoid prolonged work at home or at school.
Take a break
Like all of us, your child will need a complete break from work every few months. Some parents have even reported a sudden surge in speech when they have taken their child out of town or away on holiday. When you resume work with him, you may need to start slowly and build on that over a week or two.
I often get mothers calling up and asking about toilet training. Toilet training in typical children starts at around 2 to 3 years. When you feel you child is ready, you need to remove his nappy and allow him to feel the discomfort of the mess in his pants for a while before changing him. You need to start with training him to pass urine. To start serious training, you need to set aside a weekend. You need a buzzer or beeping timer, a portable toilet that he can easily sit on and lots of reinforcers eg. bits of sweets, chocolate or some other rewards. Do this exercise in the living room or area that he plays in. Give him lots of fluids to drink - juice, water, lemonade etc. Set the timer to go off every 15 minutes and each time it goes off, sit him on the toilet for around a minute. Do not pressure him to do anything. If he passes even a little urine, reward him immediately so he associates the reward with doing the job. Allow him access to the portable toilet until he is ready to use the regular toilet.
A child with Autism must be encouraged to do things for himself. A system called reverse chaining can be useful here whereby a task can be broken up into steps. A simple example is pulling up his pants. Start by pulling up his pants up for him until they're almost on and get him to do the rest. Do this for a number of days until gets the hang of it. Then try to get him to start between the knees and hips. Before you know it, he will do it from the ankles up. Although this is time-consuming and many parents would simply dress the child themselves, the extra effort involved in reverse chaining will encourage the child to be independent and have more self-esteem. When his language improves, get him to order something he wants at a place such as McDonalds whilst you watch from a distance. Choose a quiet time initially when he doesn't have to queue up as this itself is a feat on it's own. Another vital area where a child with Autism must be taught early is safety in his environment.
Safety awareness and Autism
Safety should be encouraged from a very early age. Crossing the road is difficult for any young child and you would need to hold the child's hand whenever near traffic. However, instilling the basic concept of traffic awareness can begin very early. What I did with my own son was to hold his hand and ask him to tell me when it was safe to cross, asking simply "Is it safe?" I got the idea when I saw him eager to cross the road to his favourite video library. He soon worked out he had to look both ways for traffic before answering "yes" or "no". Within a week, he understood the concept completely. Teaching generalization is often a problem for children with Autism. To teach a child with Autism to generalize the principle of not running across the street, it must be taught in many different locations. If he is taught in only one location, the child will think that the rule only applies to one specific place.
Never miss an opportunity to teach your child. One parent reported that she had huge success with her child when he was outside playing on the trampoline or swing. She would get him to recite nursery rhymes and songs here with considerably more success than when they were indoors at the table.
Studies have shown that swings are the number one cause of injuries to children in the playground. Very young children with Autism are especially in danger as they will be more unaware of the danger. After a couple of close calls, I got the idea of hanging a boxing bag in one of the doorways of our home. The children were allowed to hit, punch and push the bag that was hung a few inches from the ground. In no time at all, they became aware that they had to stay out of the way of a heavy swinging mass.
Getting your child to interact with the computer
A home computer is a valuable teaching tool for your child. Most children with Autism are naturally attracted to the sights and sounds of a computer. Children as young as 12 months and even younger are able to sit on their parents' laps and interact with a home computer. Very few children under the age of three will be able to operate a mouse. DON'T waste valuable time waiting for this to happen. A child will be able to use a touch-screen long before he can use a mouse. Touch-screens allow a child to navigate around a program by touching the screen directly instead of co-relating the movements of the hand to the mouse cursor (a difficult feat for some adults!).
There are two types of touch-screens:
a) where the monitor's screen is touch-sensitive (expensive) and
b) the add-on touch-screen, pictured below, which you can place over your existing monitor (cheaper alternative). The add-on will come with some software and an adapter to connect to your mouse input. Get the one that allows the use of your mouse as well so your child can use the mouse when he is ready. Leave the mouse at the side of the keyboard. Your child will eventually start using the mouse and you can then discard the touch-screen add-on.
A child with Autism must be encouraged to play and associate with typical children of his age or even slightly older. Given the choice, encourage him to interact with more vocal, animated children rather than shy, quiet kids so his speech will be stimulated. Children often respond better to feedback from their peers than from their parents or therapists. Watch them play together. Those that involve him in play will be of most benefit to him. Play dates with other children is an excellent idea. Children with Autism often don't like going to unfamiliar places and seeing unfamiliar faces. Brothers and sisters are always a huge advantage. Imitation and turn-taking are the cornerstones of communication. From an early age, you must expose them to as many different environments and people as you possibly can.
Talk to your child
If you remember just one thing from this document, please remember this - The best and simplest advice for anyone who has a child with Autism is to keep talking to your child, telling him what you're doing, what is happening and what is going to happen. Children with Autism like routine and you can use this to the best advantage. Use terms simple enough so the child understands and of course speak at a speed the child can absorb. Avoid long strings of verbal instructions. People with Autism have problems with remembering the sequence. If the child can read, write the instructions down on a piece of paper. An agenda or chart of daily events and events within the day preferably in the form of images that can be put up on a notice board is an excellent idea. If the child can read, a written list can often help. If he can't read yet, you must use images.
What not to teach your child
A typical child could easily pick up two or even more languages before the age of six. However, I would never suggest you try teaching a child with Autism more than one language. Also, although other subjects such as maths, science etc. are important, keep a strong focus on your child's speech and language. There's not much use forcing the issue with other subjects if your child's language skills can't keep up.
The second thing is religious studies. Concepts such as God, Hell, Devil, Heaven and the like can be very confusing and even scary concepts to a child with Autism. I personally would leave this to a much later stage in the child's development. There are many more things you could be teaching your child in the mean time.
Encourage your child to join the school choir or take up singing lessons. Kids with Autism often speak in monotone. Singing will help develop the range in your child's voice.
Setting up maths situations to real life is far more stimulating than just written sums on paper so be imaginative and use real objects, money, prices at the supermarket etc.
Facts, facts, facts!
It is an excellent idea use a spreadsheet such as Excel to build a list of general knowledge facts to teach your child such as "Is a whale a mammal or a fish?", "Which is the largest continent on Earth?" etc. and to present around 7 new questions a day to your child. You will be amazed how many your child can learn. In less than 2 years I had already taught my child over 4,000 such everyday facts. Make sure you use solid ABA principles to ensure the child remembers these facts.
Always insist on a response
Once your child starts to respond to you in any way, be it verbal, with a picture, symbol or other, you must always, always, always insist on a response to anything you ask him. It is a lot easier to do the opposite but if you do so, he will soon learn he is able to get away with no response and his communication will suffer.
Many children with Autism could at some stage exhibit behavior such and head-hitting and hand-biting. This can be very distressing for the parents. It is usually a sign of frustration, a call for attention or both. Most kids outgrow this behavior. You should never outwardly react to such behavior and should only intervene if you feel the child will do himself some real harm.
Listen to your child
Once your child becomes verbal you must document what he knows and understands. Listen to your child and document any new words you think he knows or should know. I started with just a handful of words on an Excel spreadsheet. Keeping this document for my child was extremely valuable as I made sure he knew and understood the words. The list grew to over a thousand words in less than 12 months. I also introduced new frequently-used words into the list and used pictures to ensure he knew what they meant. By not keeping a live document, you risk your child loosing words and ultimately having a very limited vocabulary.
Watch your child
If you are one of those fortunate parents who has a 'scribbler' for a child, i.e. a child that loves to scribble text and images, then a) make sure he has lots of blank paper and writing materials at hand. b) Look at what he is scribbling. Chances are any text he scribbles is text he has seen before and possibly understands. You must check these words are in his word bank. If they are not, enter them in. It is of course important to watch how you child interacts with others and how they interact with him. If there is very little interaction, it may be time to find new friends for him. Friends that make the effort to involve him in play are worth their weight in gold. I sometimes indulged in a little bribery with my son's friends eg. play this game and we'll go to McDonald's later. It's true your child needs reinforcement but his friends may need a little motivation booster as well!
Never lie to your child
It is often tempting to lie to your child to get him to behave eg. "If we leave quietly, I'll take you to the toy shop" - and then you take him home. Avoid doing this as it will only confuse your child. Children with Autism often have trouble understanding the concept of deception. Lying to him will only cause frustration and mistrust.
It is tempting to 'bribe' children into doing work or some non-preferred activity. Avoid doing this with autistic kids. The better approach is to reward them after they have done well in some task. They will soon make the association between good behavior and reward.
If your child keeps failing with an exercise, drop it and try something else - you can always come back to it later. For example when we tried to teach our son categories i.e. animals, plants, people etc. he couldn't get it. We dropped it and continued with pictures and labels. Around four months later, we came back to categories. He matched the pictures to their categories with almost no help at all. Children all develop differently and each child will learn at a different pace.
A child with Autism will become a loner if left to himself and his language and social skills will suffer. From an early age, you must involve him in whatever is happening with his siblings and peers. There is no better way to teach him.
A child with Autism often has what is known as sensory overload. He needs a bit of time, space and possibly a peaceful environment at least every few hours to do what he wants so long as it's not too destructive in some way.
Bad news and Good news
You will have heard enough about the bad news on the prospects of children with Autism. Typical children have certain expectations of their peers and a child with poor language and social skills even at a very early age can easily become a social outcast, made fun of and even bullied. We all know children with Autism need help. Here's the good news - They can all be helped! It takes hard work and determination on the part of his parents, teachers and those working with him. I know of parents who have given up work and worked full-time for three years to work with their children to get them into a mainstream school. A couple of minutes a day playing with your child on the floor is simply not enough. You need to grab his attention and draw him out of his world and into yours, showing him, teaching him, involving him and above all making it all fun!
Don't look too far ahead
Looking too far ahead and imagining the worst-case scenario is a waste of your time and energy. Work hard with your child today and plan his work for the next, taking one day at a time and moving up one step at a time. People who have done this have had the best results with their children.
As a parent or educator of the child, you need to be mentally prepared for the task ahead of each day. It goes without saying that you also need to set aside time each day to work with your child, prepare materials, print, laminate, organize materials, record data etc. You will find the early months the hardest. But life will begin to improve for the whole family as your child progresses.
It is always tempting to compare your child with other kids with a similar condition to see where they measure up. Try to avoid this as there will always be kids with capabilities above and below your child. Rather, try to aim for the milestones of typical children.
Many parents will not tell others about their child's condition. This is a personal thing although some people simply must be told eg. teachers and those in constant contact with the child. That way they can keep an eye out for the child. In a classroom setting they may find it helpful to keep the child towards the front of the class. As time progresses and your child improves (with lots of hard work of course) and he starts to blend in, you could tell eg. his new tennis teacher that he simply has a "speech delay" so he doesn't treat your child like a cripple. The rule of thumb is to tell people as much as they need to know. You will have to use your best judgment.
A child with Autism will generally begin attending school with an aide. Depending on the ability of the child, it is recommended that the aide be 'faded' at some stage i.e. the child should be less reliant on his aide and take instruction from his teacher. This could begin in the second or third year at school. Fading should begin with certain classes eg. P.E. (physical education) and sports, then art class etc. Do not attempt to fade the aide from all the classes at the same time or the child could struggle and become frustrated. The aide could start by spending less time with the child in the classroom and could share her responsibilities with other aides or other children. If the child starts to struggle, the aide should be brought back. Flexibility is very important here.
All children respond to love and the best people to get involved in a child's learning process are those he will trust first - his own parents. The keyword in early learning is "early" - a child is never too young to learn. The young mind has startling capabilities of memory and learning. This is why it is easier to teach young children more than one language than it is to teach an adult (although, as mentioned before, I personally would not confuse a child with Autism with a second language). Don't be afraid to put as much new material in front of your child as you can - you need to push the limits of your child but without pushing him over the edge! Each day a child goes without learning something new is a lost opportunity.
Our multimedia software was the result of sheer desperation. We simply couldn't get the huge volume of good quality images and sounds our son's home-based program demanded so we decided to create our own. Our software is now used in special education centres around the world.
Autism need not be a life-long sentence if you do enough work with your child in his early years. Your biggest enemy is time. Our own son has benefited enormously from just three years of intensive home-based work. At three he could barely say a word and would not respond to his own name. At six, he was in a mainstream school and taking swimming, karate, tennis and music classes. He regularly surfs the net and plays computer and internet games. He can read, write and spell two years above his grade.
Helping a child with Autism on the road to recovery (and recovery has been achieved by many) is expensive in terms of time, energy and other resources. Doing nothing will ultimately cost a lot, lot more. Our children are our most precious resource and must be given every opportunity to achieve their full potential.
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