What To Look for in Your Child’s Autism Assessment

Determining when and where to get an assessment for autism can be a daunting task for parents. Time, money, and finding a clinician trained in autism assessment in your area are all things that have to be considered.

Luckily, experts in autism have devoted extensive time to help determine the best procedures for providing a valid autism diagnosis. Below I have outlined a “best practices” core assessment battery for children when autism is suspected.

An Autism Diagnostic Assessment Should Include:

1.       Parent Interview – The parent interview about the developmental history, family history, and the child’s individual strengths and challenges is the foundation of the assessment.

2.       Direct Observation – The child should be observed engaging in various social interactions. The Autism Diagnostic Observation Schedule – 2nd Edition (ADOS-2) and the Childhood Autism Rating Scales-2nd Edition (CARS-2) are well-researched measures that provide robust information about the child’s behavior as it relates to symptoms of autism. Using the ADOS-2 or the CARS-2 as a direct observation measure is very beneficial to describe the child’s social strengths and weaknesses.

3.       Assessment of Cognitive Development – Cognitive functioning and problem-solving are an important part of a child’s development. An assessment of your child’s cognitive development can help inform intervention. It can also provide a baseline of your child’s functioning. Intensive applied behavior analysis (ABA) therapy has been shown to increase cognitive and problem-solving abilities in some children.

4.       Assessment of Language – An assessment of your child’s understanding and use of language is very important. Most cognitive assessments will include an assessment of verbal reasoning and vocabulary knowledge that will provide some information about your child’s language skills. Additionally, direct observation of your child during the assessment can provide an informal assessment of language and communication skills.

5.       Adaptive Behavior Assessment – Adaptive behavior describes what a child is able to do on their own. An adaptive behavior assessment can help determine what level of assistance a child needs when compared to others their age.

The information from each domain above should be integrated into a report by a licensed psychologist (PhD or PsyD) or a physician (MD or DO) that details the diagnostic classification that best describes your child. Recommendations based on the best available research and the priorities for treatment should also be included.

Remember that the above outline is describing the essentials of a “best practices” autism assessment. Additional assessment of other areas of functioning may be needed depending on the concerns for your child. The psychologist or physician will let you know if other areas should be added to the core autism assessment.

For more information about securing a best practices autism assessment at ABA Connect, please call us at 512-900-8116.

Enjoying the Holidays with a Child on the Spectrum: Visiting Santa

By: Caroline Roesel, MEd, BCBA

Parents want their children to experience the “magic” of the holiday seasons and partake in as many activities as they choose. This can be challenging with a child on the spectrum who may want to partake in holiday activities, but have behaviors that may preclude them from doing so.

Parents who want their child to visit Santa Claus may worry about their child feeling anxious in large crowds, having a hard time waiting in line, and sitting still in Santa’s lap (without crying!). This is overwhelming enough to make caregivers give up before even trying. By using a few principles of behavior and planning ahead, your child could master the skills needed to have a great experience visiting Santa.

Managing Crowds:

If your child is overwhelmed by large groups of people, contact Santa’s place of work and ask when there are typically less people. Smaller crowds are more common when Santa events first open; if you can arrive a bit before the event opens, you will likely encounter shorter lines.

Most children have toys or treats that help them cope when they are overwhelmed. Bring these items with you to the event. Watch your child; they will likely demonstrate “warning signals” that let you know when they’re growing uncomfortable. When you see these warning signals, give them their toys or treats. Do no wait until they are having a tantrum to try and calm them, this may inadvertently teach them “When I have a tantrum, I get cool stuff.” Not the message you want to send!

Contact Santa’s Helpers:

Many Santa events often have a contact number. You can call to let the event workers know that you’re coming and you have a child with special needs. Tell them if your child would be more comfortable with certain changes, such as a speedier Santa visit, standing next to Santa instead of sitting on his lap, or giving Santa a list of desired presents instead of telling him verbally. People are happy to accommodate when they can, so don’t hesitate to ask for help.

Practice at Home:

If you want your child to take a picture with Santa, but are worried they will not tolerate sitting with him, practice taking pictures with different family members and family friends before you go to the event. Have your child go through the motions of sitting on someone’s lap and smiling at a camera. Try and practice this as much as you can 3 to 4 days prior to seeing Santa. The more comfortable your child is in front of the camera, the more likely they will be to say “Cheese!” on the big day!

Children with ASD can be a part of holiday fun and festivities. With a little planning and practice, caregivers can help their children with special needs to partake in the fun!

Decrease Autism-Related Shopping Meltdowns

Meltdowns happen. But, there are ways to decrease the likelihood your child will have a shopping meltdown. In my previous blog I discuss tips to understand shopping meltdowns. In this blog, I outline simple ways to decrease autism-related shopping meltdowns.

Tend to basic needs first

Before a shopping trip, tend to your child’s basic needs. Make sure they are not hungry, they are rested, and they have received positive interactions with others such as play time with parents, peers, or siblings. Hunger and fatigue make children (and adults) more irritable. Before shopping, you could have a snack with your child and ensure you are attending to and delighting in their positive behaviors. From your child’s point of view, shopping likely means a lot of difficult to manage sensory experiences (sights, sounds, and smells) and adult correction. Therefore, it is important to ensure positive interactions (even for 5 minutes) before a potentially stressful shopping trip.

Use a visual schedule and list

As much as possible, let your child know about the shopping trip before it happens. Visual schedules are incredibly useful for children with autism. Add shopping trips to your child’s schedule, and better yet, try to have a routine grocery shopping or errand day each week. This will help increase predictability for your child. A visual shopping list with smart phone apps, pictures, or clip art can also help your child actively participate in shopping.

Identify meltdown triggers

Identifying meltdown triggers can help caregivers stay one step ahead of potential meltdowns. Some caregivers find that headphones, sunglasses, a soft object to hold, or the child’s favorite foods can help reduce meltdowns. If you observe your child is becoming upset, take a moment to help them calm down before the frustration builds. This may require a pause in shopping so a full meltdown does not occur.

Teach calm shopping behaviors

Children need to learn what behaviors are expected. Some children need explicit teaching and modeling. Social stories and video modeling can help children learn appropriate social behaviors. Video modeling can include having your child watch a video of another child successfully shopping with an adult or a short clip of themselves engaging in calm behavior while shopping. Children may need specific reminders and prompts at different points of the video to ensure understanding. Parents can also attend to calm behaviors during the shopping trip with praise (“Nice inside voice!”) and positive gestures such as a high five, or introducing small portions of food for the child’s “calm” behaviors.

Plan

Planning can help prevent meltdowns. Make a shopping list, decide what shopping items are most important so you can get those items first, and try to reduce the total shopping time. If you ensure you have plenty of planned strategies to help your child stay calm, your child can learn how to manage the stresses of shopping.

Understanding Autism-Related Shopping Meltdowns

Children do not always go along with the shopping plan easily. Autism-related meltdowns can make shopping even more difficult. Understanding autism-related shopping meltdowns can help you and your child experience less stress during a shopping trip.

Carefully observe your child’s triggers

Observe what happens before your child has difficulties. Most children are more likely to have a meltdown if they are hungry or tired. A common trigger for children with autism also includes sensory overload. The lights, sounds, smells, and crowds from a shopping trip can trigger a meltdown. Shopping at the popular grocery store on a Saturday may be more stressful for your child because it is loud and chaotic. You might observe that the smaller, less-crowded grocery store does not trigger a meltdown.

Understand the difference between meltdowns and tantrums

Both meltdowns and tantrums can include screaming, crying, falling on the floor, self-injury, and destruction. But, meltdowns and tantrums happen for different reasons. I define a meltdown as the visual display of a child becoming overwhelmed in response to a trigger. Meltdowns do not immediately stop when a child is given what they want or when they are taken out of an unpleasant situation. The intensity of emotion during a meltdown may take a minute (or more) to decrease.

Children throw tantrums to gain access to something (attention, food, toy,  etc.). Children also throw tantrums to avoid something (unpleasant activity, ending play, bedtime, mealtime, etc.). You can usually stop a tantrum by giving the child what they want (leaving the store, that special toy, attention, etc.). A child having a tantrum may also watch for your reaction to see if the tantrum is working.

Conduct an experiment

Parents can carefully observe and implement systematic changes to decrease the likelihood of a meltdown. If you know your child’s triggers, you may be able to modify the trigger. For example, if a change in your child’s drive home from school triggers a meltdown, plan to give him or her ample notice (verbally or visually) that a shopping trip will occur. If the grocery store’s fluorescent lights are too bright, consider ways to reduce the child’s exposure to the lights.

Understanding autism-related shopping meltdowns gets us one step closer to improving your errand-running experience! On my next blog, I will provide tips to prevent meltdowns.

Make A Plan to Avoid Santa Trauma

Make a Plan To Avoid Santa Trauma

Make a Plan To Avoid Santa Trauma

The holidays can be a difficult time for children with autism spectrum disorder. Difficulties can arise from changes in schedules, blinking lights, shiny objects, crowds, or the man with a hairy face that only comes once a year in a big red suit and loudly proclaims, “Ho Ho Ho.” Santa Claus can be intimidating for any child. As a parent of a child with autism, make a plan to avoid Santa trauma.

Santa Trauma

Santa trauma is not a “clinical” term. That is, Santa trauma is not a diagnosis. But, many of us have seen children cry, reach out for their parents in terror, or look petrified as they sit in Santa’s lap to take a picture. We have also seen stressed adults escorting children to sit in Santa’s lap despite the child’s apparent fear.

I define Santa trauma as significant emotional or behavioral reactions that happen when children (or adults) encounter Santa Claus. Santa trauma can happen while waiting in a line to sit in Santa’s lap, walking by Santa at the mall, seeing Santa on TV, or actually being forced to sit in Santa’s lap to take a picture. You or your child can experience Santa trauma. You may no longer have your child sit in Santa’s lap because the last time you tried it, your child had a meltdown and you are traumatized as a result. On the other hand, you may have wanted your child to have a big smile in a picture with Santa and he showed no reaction. Consider how to make a plan to avoid Santa trauma.

Santa Trauma From The Sensory or Social Experience

A child with autism spectrum disorder may have an intense response to Santa or he may look away because he has no social interest in Santa. Santa Claus provides a unique sensory and social experience because he only comes around once a year. Santa trauma can be triggered by Santa’s novelty or sensory overload from Santa’s big red textured suit, white furry beard, his big black boots and belt buckle, or his hearty “Ho Ho Ho.”

Make A Plan To Avoid Santa Trauma

You may need to make a carefully thought out plan to avoid Santa trauma. You know your child best. Think about how you can avoid or address a potential meltdown from a Santa encounter. Here are some tips if you do plan to introduce your child to Santa in person.

  • First, introduce your child to Santa in pictures, books, cartoons, stuffed animals, videos, or from a distance.
  • Talk about Santa in a way that is consistent with your family’s values.
  • Consider a sensory-friendly version of Santa through events for children with special needs.
  • Praise your child for any Santa approach such as looking at, going near, saying or approximating the word “Santa.”
  • Have a family member dress up as Santa for a controlled introduction in a familiar environment.
  • If you go to an event to take a picture, check your child’s reaction to Santa from a distance and the wait time before standing in line.
  • Make sure your child is well-rested and fed before the initial encounter with Santa in public. Have their favorite items readily available.
  • Do not force your child to sit in Santa’s lap if he is afraid or is on the verge of a meltdown.
  • Consider modeling a high-five or a fist bump if sitting in Santa’s lap is too frightening.
  • Be ready to leave the event if your child is upset by Santa, then do something you know calms your child.
  • Don’t feel pressured to visit or introduce Santa if you feel your child is not ready.

Make a plan to avoid Santa trauma. It does not have to happen to you or your child during this holiday season.