What Works

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What Works
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1 Aim for Consistency
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The following quotation illustrates why there is
a determination to create order(Jolliffe et al
1992)

• Reality to an autistic person is a confusing,
• interacting mass of events, people, places,
  sounds
• and sights. There seem to be no clear
• boundaries, order or meaning to anything.
• A large part of my life is spent just trying to
• work out the pattern behind everything. Set
• routines, times, particular routes and rituals
  all
• help to get order into an unbearable chaotic
  life.
• (p.16)

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Being Consistent in Our Expectations

• Having realistic expectations
• Having positive expectations
• Having Shared and Agreed Expectations

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Being Consistent with Communication

• Levels of understanding
• Physical space
• Processing time
• Visual Supports

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Being Consistent in the Way We Offer Support

• Routines
• Consistent across environments
• Consistency across the child day
• The need for good quality recording

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Being Consistent in the Way we Respond to
Behaviour

• Consistent in our individual responses
• Consistency across staff teams
• The need for good quality Behaviour Support Plans
  and Programmes.

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2 Understanding the Individuals World

• Geoff the only way you will understand is if you
  put my brain inside your head then you will see
  things properly.
• No short cut to understanding (listening and
  observing)
• Try to appreciate their take on life, feelings,
  emotions, anxieties.
• Recognising their uniqueness.

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3 Build on Existing Strengths and Skills

• Avoiding the needs led approach
• Starting with strengths and emerging skills

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4 providing Meaning Through Structure

• Structure helps provide answers to the following
  questions
• Where am I supposed to be?
• What am I supposed to be doing?
• How will I do it?
• Who is going to be with me?
• How much do I have to do?
• When will it last?
• What will I do next?
• Structure helps the individual learn and feel
  safe.

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Types of Structure

• Physical structure
• Individual structures
• Work, task structures

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5 Ensuring that they Have a Means of
Communication

• Communication support based upon careful
  observation and consultation
• Communication based upon preferred ways of
  learning
• Visual
• Auditory
• Kinaesthetic

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Communication Difficulties in Individuals with
autism

• May not understand the purpose of communication
• May not initiate communication
• May not show or share interest
• May not develop speech 50
• Speech may be delayed
• Limited or inappropriate use of eye contact,
  gesture, facial expression and body language

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Communication Difficulties in Individuals with
Autism

• May require extra time for language to be
  processed
• May have a good vocabulary, speak fluently but
  lack understanding
• May have a good vocabulary, speak fluently but
  struggle to communicate
• May talk at you.
• May have difficulties with the give and take of
  conversation

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Supporting Communication

• Supporting through the environment
• Always begin with their name
• Ensure that they know that you are talking to
  them
• Give time for communication to be processed
• Explain metaphors and idioms
• Dont overload with too many words

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Supporting Communication

• Use visual supports
• Try to understand the frustration of not been
  able to comprehend other peoples communication or
  to express your own needs, wishes or feelings

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6 Addressing Sensory Issues
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Location and Function of the Sensory
System System Location
Function Tactile
Skin- density of cell distribution
provides information about touch
throughout the body.Areas of the
environment and greatest density
include mouth object qualities(touch
hands, genitals )
pressure,texture,hard,soft
,
sharp,dull,heat,cold,p
ain) Vestibular Inner ear stimulated by
head Provides information about
balance movements and input from
Where our body is in space
other senses especially visual and
whether or not we or

our surroundings are

moving.Tells about speed

and direction Olfactory Chemical
receptors in the nasal Provides
information about smell
structure- closely associated
different types of smell with
the gustatory
(musty,acrid,putrid)
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System Location
Function Proprioception Muscles and
joints activated Provides information
about body awareness by muscle contraction
and where a body part is and
movement how
it is moving Visual Retina
of the eye- stimulated Provides
information about sight
by light
objects and persons.Helps us define
boundaries as we move through time and
space Auditory Inner ear
stimulated by air Provides information
about hearing /sound waves
sounds in the
environment (loud,soft,high,low,near,far)
Gustatory Chemical receptors in the
Provides information about taste
tongue- closely entwined
different types of taste (sweet
with the olfactory (smell)
sour,bitter,salty,spicy )
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THE PERCEPTION OF SOUNDS

• I was frightened of the vacuum cleaner, the
  food mixer and the liquidiser because they sound
  about five times as loud as they actually were.
• The bus started with a clap of thunder, the
  engine sounded four times as loud as normal and I
  had my hand in my ears for most of the journey.
• While I was typing the capital I in the last
  sentence the dog scratched and her collar jangled
  so I heard a crashing painful noise.
• Another trick my ears played was to change
  the volume of sounds around me. Sometimes when
  other kids speak to me I could scarcely hear them
  and sometimes they sounded like bullets.
• (White and White)

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Ways Forward

• Try to provide warning of loud noises
• Ensure that you have the childs attention before
  giving important information
• Provide a visual cue when you want the child to
  listen
• Dont presume that the child can look and listen
• Provide a quite place for the child to retreat to
• Provide the child with a means of indicating that
  they cant cope with sounds/noise
• Provide the child with earphones

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Ways Forward

• Provide the child with background music to help
  them stay calm
• Provide the child with music to block out
  unwanted sounds
• Vary the tone of your voice
• Only have one person at a time speaking
• Dont have TV, music on at the same time

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Visual Perception Possible difficulties

• Sensitive to changes in light
• Doesn't like bright sunlight
• Uses fingers to filter light
• Have difficulties finding what they are looking
  for
• Difficulties with writing, spaces between words
• Problems concentrating when in a room with
  fluorescent lighting
• Possible with difficulties certain colours
• Bumps into things

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Possible difficulties

• May prefer to use peripheral vision
• Inability to distinguish between foreground and
  background (can result in sensory overload)

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Ways Forward

• Try to identify colours that may cause a problem
  for your child
• Experiment with colours
• Try breaking up long corridors etc with colour to
  provide a point of focus
• Put tape on edges of steps to help with
  processing depth
• Allow to explore new environments
• Have a area with reduced visual stimuli
• Remind the child what to look at
• Teach the meaning of facial expressions

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Touch

• Doesn't like the feel of towel on skin
• Doesnt like been splashed
• Doesnt like teeth been brushed
• Becomes upset when touched
• Doesnt like wearing new clothes
• Doesnt like getting hands dirty
• Cant cope with food round mouth
• Avoids been touched

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Ways Forward

• Gradually introduce new clothing
• Involve the child as much as possible with
  washing and bathing, allow the to control how
  much pressure is used.
• Try different lengths of clothing (shirts,
  trousers)
• Heavier blankets may help with sleep difficulties
• Observe the child's responses to different
  textures in the environment and make adjustments.
• Try to give warning of touch (first we wash your
  hands then your arms)
• Keep wipes handy

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Gustatory

• Myles et al,(2000) more than one third of
  children with AS
• Avoided certain tastes that are typical
  in children's diets
• Would only eat certain foods
• Were picky eaters

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Ways Forward

• Respect individual differences
• Introduce very small bites or portions
• Introduce similar foods to ones currently
  preferred
• Always proceed with caution and take advice

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Proprioception

• The muscles and joints and joints send messages
  to help us carry out basic movement functions
  such as ,stand,sit,hold things and balance
• This system allows us to carry out movement tasks
  without looking.

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Ways forward

• Try using heavier items (plates, cups) so that
  they are more easily registered
• Provide visual information for sitting at desk
• Encourage the use of squeeze balls etc
• Provide opportunities for large motor
  activities,pushing,jumping and pulling
• Do activities that that encourage and develop use
  of whole body and coordination
• Consider the type of fasteners on clothing
• Use clay etc to develop hand strength

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Vestibular System

• Vestibular system is involved in
  movement,posture,balance and coordination of both
  sides of the body
• Approximately 50 of children with A S
  experience difficulties in this area
• Can be hyper or hypo sensitive
• Hypersensitive children have difficulties with
  anything that involves movement particularly
  involving changing direction, speed. This group
  can fear having their feet of the ground
  (Gravitationally insecure)

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Possible Difficulties

• Difficulties changing directions
• May find sports difficult
• May have difficulty changing speed
• May be afraid to have their feet off the floor
• May loose their place when reading from a board
• Putting trousers on may cause problems
• May turn whole of body to look at a person
  rather than only head
• Engages in bouncing, spinning

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• Humans are the most illogical race.
• Nothing they say,
• Nothing they do,
• Makes any sense.
• Oh, why cant humans be logical?
• (Dianne Mear 1994)

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Ironing Out the Wrinkles

• Life was one a tangled mess.
• Like missing pieces, in a game of chess.
• Like only half a pattern for a dress.
• Like saying no, but meaning yes.
• Like wanting more, and getting less.
• But Im slowly straightening it out.
• Life was once a tangled line.
• Like saying yours, and meaning mine.
• Like feeling sick, but saying fine.
• Like ordering milk, and getting wine.
• Like seeing a tree, and saying vine.
• But Im slowly straightening it out.
• Life is now a lot more clear.
• The tangles are unravelling.
• And hope is near.
• Sure there are bumps ahead.
• But no more do I look on with dread.

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7 Providing Meaningful Activities

• Activities based upon strengths and preferences
• Meaningful to the individual with autism
• Making available a full range of activities
  (broad and Balanced)

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8 Work on Developing Quality Interaction

• Making the most of naturally occurring
  opportunities
• Teaching social interaction

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• One foot in and one foot out
• is what Aspergers all about.
• Sometimes I think why me
• other times I think its the best way to be.
• A little different from the rest
• makes you think your second best.
• Nobody quite understanding
• a hard life which is very demanding.
• I look like any other child
• but things just make me wild.
• (Vanessa Royal)

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Social InteractionAreas of Difficulty

• Lack of awareness of other people
• Lack of interest in other people
• Unaware of social requirements in terms of
• Location private public)
• Who they are talking to
• Timing (when people are busy))
• Making friends
• Wanting interaction but not knowing how

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Social interaction

• Interacts but not always appropriately
• Not knowing what interests others
• I dont feel any need for social interaction,
  left to my own devices, I am never bored or
  lonely.
• Paula Johnston

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General Approaches to Social Interaction

• Social stories
• Coaching cards
• Role play
• Become a social interpreter for the child
• Using a buddy system
• Social Cartooning
• Video Modelling

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Social Stories
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Why children have pencils in my school

• I use pencils to colour with.
• I use a pencil to draw and write with.
• Some authors use a pencil to write a story.
• My teacher likes it when everybody puts
• their pencil on the table when they are not
  writing.
• I will try and put my pencil on the table when I
  am not
• writing, drawing or colouring.

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Work experience

• All my class are going on work experience soon.
  We are all
• deciding what we would like to do for our work
  experience.
• Work experience will help me decide what I want
  to do
• when I leave school.
• I will be visiting my work placement with Mrs
  Wyatt before I
• start. I will meet some people I will work with.
  It will be
• helpful if I tell them my name and say hello.
  When they talk
• to me, I will look at them too. Most people like
  it if I do this looking,
• listening and talking.

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Work Experience

• I am going to Musco Industries for two weeks.
  When I go there I will not
• wear my school uniform, as I might get it a bit
  dirty. I have to be there
• at 9 oclock. I am taking a packed lunch to eat
  in the canteen with the
• others. There is a morning break and an afternoon
  break, when I can buy
• biscuits or chocolate, so I will need some money.
  If I need any help, I have
• a work buddy called Ruth who will be available.
• I will have a daily timetable to tell me what to
  do each day. The people at
• work will like it when I follow the timetable. If
  I am worried I will try to talk
• to Ruth during the breaks.

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Cartooning

• Draw about the given situation
• Present the present perspective
• Provide sequence or structure
• Summarise the cartoon
• 5. Identify new solutions

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Comic Strip Conversations
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Comic Strip Conversations
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Visual Supports
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9 Try not to Take it Personally

• Its not your fault
• Most of the difficulties are not about me
• I am not expected to have all the answers
• The success of the day usually outweigh the
  failures

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10 Look for Creative Answers to Difficulties

• Try to avoid, weve always done it this way or
  we have to do it this way because of the autism.
• If its not to expensive and it does no harm then
  try it.

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11 Work in Partnership With the Individual With
Autism

• Dont get into conflict
• Listen to their point of view
• Learn by observation
• Enable them to solve their own problems

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