Wrapping Things Up

Hello everyone,

Thank you so much for following this blog! During these few weeks, I have learned so much about ABA therapy and the world of ASD diagnosis and treatment! It has been a great experience, and I am glad I got to share it with you all. Thank you for taking the time to read and comment on this blog.

For those interested, I have attached a pdf file of my final presentation. Once again thank you!

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The World is Overwhelming Sometimes: ABA Sessions

So far in this journey of understanding ABA therapy, I have covered everything from emotions and basic prompting to larger applications like generalization.

Many people on the autism spectrum have difficulty processing sensory information. These sensory differences can affect learning and day to day behavior.

Sometimes an autistic person may behave in a way that you wouldn't immediately link to sensory sensitivities. A person who struggles to deal with everyday sensory information can experience sensory overload, or information overload. Sensory overload occurs when the brain and the nervous system  become bombarded with too much sensory input from one or more sensory systems and cannot process and sort out the incoming sensory messages. This can ultimately cause stress, anxiety, and possibly physical pain and can result in withdrawal, a meltdown and change in behavior and like not adhering to directions.

The main areas of processing difficulties are seen when a child is hypersensitive or hypo-sensitive to the seven senses which are sight, sound, touch, taste, smell as well as balance (vestibular) and body awareness. For example, a child with hypersensitive vision could have distorted vision when objects and bright lights appear to jump about. They may find it easier to focus on one spot of detail because the surroundings can be overwhelming especially if it is distorted, too bright and fragmented. They may avoid certain rooms, lighting, objects as it may increase their sensitivity.

To help someone on the spectrum with sensory overload, watch and be prepared. Take note of the environment at all times and keep it away from the triggers when possible. Watch for signs and sensory signals of possible overload and respond right then and there. Don't push through, and be there for them.

I hope you have all enjoyed these ABA sessions as much as I have!

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A Look into Autism Misdiagnosis

Over these last few weeks, I have been analyzing the results to my survey and trying to find the best way to present the most important responses and ideas to the public. For those who may not be familiar with my ASD diagnosis questionnaire, I have linked a previous post where I thoroughly describe its focus. Please check that out before continuing on with this post.

While I received some interesting responses about certain aspects of the diagnosis process, there were some additional questions in the questionnaire that did not make it to the final presentation but gave striking results as well. One of these was “Has your child been misdiagnosed with another disorder?”. The options for the responses listed various disorders like ADHD (Attention Deficit Hyperactivity Disorder), OCD (Obsessive-Compulsive Disorder), anxiety disorder and other disorders common to ASD. One of the responses was also "not sure what these disorders are". Although I made this an optional question (parents who took the survey were not required to answer this question unless they voluntarily opted to), I still got ten interesting responses.

The graph above displays the counts of misdiagnosis (parents could pick more than one) and what disorder the child was misdiagnosed with. With the disorders listed, the count for ADHD and OCD is overall the highest because they were both interchangeably picked by multiple parents. This can be accounted to the fact that the criteria for an ADHD and OCD diagnosis incorporates details similar to an ASD diagnosis. For example, according to the DSM-IV, both ASD and ADHD have a requirement for “sufficient inattentive and/or hyperactive impulsive symptoms”, which can potentially make it harder to formulate a correct diagnosis. This is why being diagnosed by the correct specialist like a child psychiatrist is so important as they are better informed about the difference between these disorders.

Astonishingly, also about half of the parents who responded to this question were not aware of these disorders. This brings forward the importance of awareness. If more families and parents were familiar with different disorders and the common misdiagnosis of ASD, then they could better understand their child’s diagnosis.

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Emotions: ABA Sessions

Sometimes it is hard for us to express our emotions to others. May it be because a certain situation, event or even time of the day, it's not always easy to tell someone how you feel. Unfortunately, for those on the spectrum it’s even harder. 

There is a persistent misconception that people with Autism lack empathy and cannot understand emotion. Autism doesn’t make an individual unable to feel the emotions, it just makes them communicate and perceive emotions and expressions in different ways. In fact, various people on the spectrum (about a half) suffer from symptoms of anxiety and depression that affect their quality of life. Although, not a lot is known about the causes of these difficulties or how best treat them. 

Studies also suggest that autistic children have greater difficulty with emotions “that are much more socially oriented" which can be anything from jealousy to pride. They also struggle with reading emotions in other people. This is accounted to problems with facial processing.  There is an area in the brain that becomes especially reared with facial processing and recognition. Over time, this area becomes stronger. In individuals with ASD, that is not the case. The amygdala (plays a play a key role in the processing of emotions) is also not well regulated which affects the processing of emotions.  Dr. Susan Bookheimer, a professor of cognitive neuroscience at UCLA, states that “rather than lacking emotion, it’s likely that autistic people struggle to “think through and work through” the emotions they experience.”

To encourage emotional developments, ABA therapists recommend these following ideas. 

1. Using emotion cards: Many therapists utilize cards that have  pictures of faces, either real or cartoon, to teach students basic emotions.

   

   This is an example of a sample emotions card.

    
2. Being responsive and bringing up different emotions in different situations: For example, if you are going to the movies bring up a conversation like “ I’m so excited to go to the movies!” This reinforces the emotion and helps the child better associate different emotions with their appropriate situations. 
3. Be involved. Read different stories, watch movies, and go to fun events with the child. Help them get exposed to the natural stimuli where they can label emotions in natural contexts. Something like, “Look he is crying, he’s sad”when watching a movie can reinforce this skill.

Emotion plays a big role in daily life. Though it cannot be directly taught, it can definitely be encouraged. 

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Wide Awake: Autism and Sleep

Falling asleep and staying asleep are particularly common among those on the spectrum. According to Autism Speaks, 80% of children with ASD have sleep-related problems. Insufficient sleep can worsen behavioral challenges, cause aggression and interfere with learning.

Recent studies have opened up some potential reasons for poor sleep in those with ASD, but more research is still underway. One possible cause includes abnormalities in brain systems that regulate sleep. Hormone levels are also being evaluated to know if they have any effect on sleep. Other medical issues ( epilepsy or gastroesophageal reflux are more common to those on the spectrum) can often contribute to difficulty falling asleep. Sleep disorders common in the general public (sleep apnea, sleepwalking, restless legs syndrome) can impact sleep as well

Fortunately, establishing good sleep hygiene can improve a child’s sleep. Autism Speaks recommends having an appropriate sleep environment that fits the child’s needs, a good bedtime routine and schedule, and exercise.

If the cause can be more specifically pointed, then better treatment approaches can be made.

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Applying What You Learn: ABA Sessions

What is the point of learning a new behavior or skill if it cannot be applied in different situations? Is a skill truly acquired if the student is unable to apply it outside the classroom or house?

Generalization is the “spreading” or “expansion” of teaching beyond what was directly or intentionally taught. It is the process of taking a skill learned in one setting like home and applying it in other settings like school or a store.  If anyone (on the spectrum or not) can do that, then they are exhibiting generalization.

Generalization is an integral part of ABA therapy and all learning. If you can teach a child to say "thank you" in the therapy room, but they never respond to other peers or adults out of the session then what is the point of that? How does the skill of saying "thank you" benefit that child? Ultimately, the goal of teaching any skill or behavior is that the child can apply it across many different environments and multiple people.

People on the spectrum tend to have a harder time generalizing. While they may be able to demonstrate a given skill, generalization is not automatically guaranteed if they are not being prompted or something about the presentation is a little different than it was when it was originally taught. Recently, one of the kids I have gotten a chance to observe is learning how to appropriately cross the street. Within a few weeks, he is able to demonstrate how to cross the street with play cars in the session. He will stop the play figure if a car is incoming and look left and right. However when taken outside to do the same thing with real cars, it is harder for him to apply the same skill. An open environment brings more distractions and stimuli than the inside.

There are many ways to generalize, including across time and people, across settings, and across stimuli.

1. Time- A child learns his numbers up to 20 last month. Today, he can still remember them.
2. People- A child can respond the same way to different people.
3. Settings- A child learns his numbers up to 20 in a ABA session. He can use those 20 numbers regardless of the environment (at home, on the playground, in class etc.)
4. Behaviors- A child learns his numbers up to 20 last month. Now he is learning numbers up to 50 and eventually 100. He’s also showing learning how to add and subtract. 

Generalization should be a part of any early intervention from the start. It’s not something extra; if it doesn’t happen, then behavior change is all but meaningless.

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April is Autism Awareness Month!

With a growing prevalence in ASD diagnosis, The Autism Society was founded in 1965 and is a nationwide campaign that helps raise awareness. The first National Autism Awareness Month occurred in April of 1970. Since then, April is known as the time where people all around the world show their support for inclusion for those on the spectrum.

What can you do to support the cause?

Wear blue on Autism Awareness Day. During the month of April, there is Autism Awareness Day, when Autism Speaks encourages everyone to be a part of their campaign, Light It Up Blue. Many places around the nation “light up blue” to support people with autism. On April 2 this year, wear your favorite blue shirt to help raise awareness for Autism.

Share the Autism Puzzle. The most recognizable symbol of autism awareness is the Puzzle Ribbon. Sharing the ribbon (on your backpack, car,  different social media platforms) is an easy way to stand with people on the autism spectrum, and spread knowledge to others.

Whether or not you choose to participate and show support this month, the important thing is support. Autism Awareness Month is a great time to show this, but the disorder does not only exist during April, so it’s essential to advocate for those on the spectrum all year-round. Happy Autism Awareness Month!

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