[Feature Article] Thots and Tots: Teaching Autistic Kids Skills for Daily Living

THERE are so many different options these days, all claiming to help children with autism spectrum disorder (ASD). There are centres, theories and remedies – but what really works?

Thots N Tots, a site dedicated to families with children managed by Malaysian journalist Brigette Rozario sat down with our director, Jochebed Isaacs to understand how to teach children with autism daily living skills.

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Teaching Autistic Kids Skills for Daily Living

Published in: Thots and Tots
Published on: 30th March 2015
Source: http://thotsntots.com/teaching-autistic-kids-skills-for-daily-living

Copyright: 123RF Stock Photo
By BRIGITTE ROZARIO

THERE are so many different options these days, all claiming to help children with autism spectrum disorder (ASD). There are centres, theories and remedies – but what really works?

As ASD is very different in each child, what works for one child will probably not work for another.

Early Autism Project Malaysia (EAP) practises Applied Behavioural Analysis (ABA) which is a one-to-one teaching programme using behavioural principles.

Jochebed Isaacs, director, clinical psychologist and a senior supervisor at EAP, calls it evidence-based treatment.

“In a nutshell, whatever behaviour you want to increase, you give a lot of attention and reinforcement to that behaviour,” she explains.

For example, if a child says “cookie” you might repeat “cookie” and then give the child a cookie. But if a child screams and cries for the cookie, you do not give the child the cookie and you try to ignore that behaviour or even walk away.

ABA was developed by Norwegian-American clinical psychologist Ole Ivar Løvaas. According to his research, 47% of children achieved “normal functioning” after two to three years of intensive behavioral treatment regimen (40 hours per week of one-to-one contact), emphasising language development and social skills.

EAP’s parent company – Wisconsin EAP (WEAP) – reportedly had a 48% recovery rate using ABA.

Red flags for ASD

Generally, one in 68 children will have ASD.

EAP’s website lists these red flag behaviours according to the US National Institute of Child Health & Human Development (NICHD):

  • No babbling or cooing by 12 months.
  • No gestures (finger point, wave, grasp) by 12 months.
  • No single words by 16 months.
  • No two-word phrases by 24 months.
  • Any loss of language skill at any age.

And, according to Robins, Fein, Barton, & Green (2001):

  • Does not point to show interest in something.
  • Does not respond when name is called.
  • Does not show interest in other children.
  • Does not bring objects to adults.
  • Does not look at objects when adult points to them.
  • Does not imitate adult’s movements.

Diagnosis

It is necessary to have a diagnosis report to get the OKU (Orang Kurang Upaya or Person with Disabilities) card from the Social Welfare Department. Those holding the card can gain aids from the government and it is also beneficial when registering the child in a government school.

Isaacs explains that while some parents want the OKU card, others don’t, especially if their child exhibits very mild autism.

Jochebed Isaacs: EAP is quite confident of diagnosing autism in kids as young as 18 months.

EAP would get the child’s medical history and oberve the child before making a diagnosis. There is quite an extensive protocol involved in the diagnosis.

Isaacs says parents can bring their child in as early as 18 months.

“We would look at the developmental milestones of an 18-month-old. We would ask parents certain questions as well. Usually by that time most children would have made certain sounds at least and they would have some joint attention, pointing at something and looking very clearly at what they want.

“So, parents who are quite aware about autism or who are quite aware of developmental milestones, would come in a bit earlier to have their child diagnosed.

“In the past we used to have kids coming in a bit later, at five or six years old, just before school-going age. Now, we get a lot of kids at two or three. At that age, parents have already observed something that’s different about their child or teachers have mentioned that the child is not together with the group,” explains Isaacs.

Children with severe autism would be at the point of not having many functional skills at all. They may have zero play skills or are not able to occupy themselves. They may not be able to talk at all. They may do a lot of severe repetitive behaviours like flapping their hands and walking back and forth. These are the stereotypical signs of autism.

At a moderate level, the child may not have very strong language skills but they would not be so severe and they can learn to take care of themselves, are independent and can occupy their time.

Then there is the mild level where the kids talk fluently and they’re very interesting but socially they may not understand acceptable behaviour.

Isaacs says she’s wary about making conclusive statements about kids with autism because everyone has varying symptoms. One child with autism will have different symptoms from another.

“Social skills at a very young age would be different. For a four-month-old child, all that would be required is for her to look at you or laugh when you laugh and smile when you smile at her. So, even the four-month-old skill might be difficult for some young children with autism,” says Isaacs.

Parents should look for things that typical kids would not do at that age or would do which their child is not doing.

Teaching skills

EAP works by breaking down each skill. For example, if you want to teach the child to speak, many parents would go to a speech therapist and he or she would start teaching the child to say words.

What EAP would do if a child is not sitting at the table nor looking at you and is immersed in a toy, is to firstly get the child’s attention.

“We would start with co-operation and basic imitation because one of the core skills of a developing child is to imitate. With our kids, because they are not attending to you, they don’t know how to copy you. So, how will they learn the complex skill of copying what you are saying?

“With imitation, you teach a child to imitate using objects first, like tapping the drum. It’s object-based so it’s very easy for the child to do it. You prompt the child to do the right thing and you praise them and give them big rewards, which is what the child wants.

“That’s the first step of imitation. The next step is to do something a bit harder which is to learn to clap your hands, so they are doing gross motor imitation. The next step would be fine motor imitation, like a thumbs-up or peace sign. Then you do the oral motor imitation like sticking out your tongue or saying ‘eee’. We don’t have to follow this process if the child is picking up faster and is already speaking,” explains Isaacs.

With this process, the skill is broken down bit by bit and the child’s skills are built strength upon strength.

According to Isaacs, the ABA programme covers all the major areas – language and communication, social skills, play skills, daily living skills, pre-academic skills and the generalisation of all the skills that the child has learned as well.

Instead of taking the child to multiple experts and centres to get help with multiple skills, EAP has it all under one roof.

“It would also be catered to the child’s abilities. If the child has mild autism, the programme can move faster as it is individualised to the child,” says Isaacs.

Customised programme

She explains that EAP has several levels of supervision – a team of therapists (so the child doesn’t get stuck dealing with just one), a supervisor (who works with the parents on the whole programme), senior supervisor who sees every child and checks that the child is progressing properly, the WEAP representative who visits once every six months and checks every programme.

This is to ensure that each child learns skills according to their needs and that the child is on track in the programme.

Parents are not excluded from the programme, as they are also trained to help their child in the after-school hours and on weekends. This is to ensure there is consistency in what and how the child is learning.

In addition, every fortnight the whole team (therapist, supervisor, parents) meet to update each other and ensure the child is progressing and everyone is on the same page.

The child can be at the centre for up to six hours daily. However, Isaacs explains that if the child is in the whole-day programme, the child would be at the centre for half a day and the balance at home. The therapists would travel to the homes with the child so that they can see the child in the home environment.

Right now the ratio of teacher to child is three to two.

While Isaacs admits a good healthy diet is important, EAP does not recommend the gluten-free, casein-free (GFCF) diet, which new research has shown can lead to early osteoporosis.

Isaacs, who has worked in this field with EAP since 2006, says there are so many things to look at and some kids come with so many different challenges that parents don’t know what to do and where to start.

“We help the parents to prioritise and focus on what to start on first. We see a lot of parents struggle with the diagnosis. I can only imagine how hard it is for a parent. What we do as professionals is try to explain the diagnosis in great detail and draw parallels with another child. We also explain the levels of grief to parents so that hopefully they can think it through and come to a place of acceptance. If they can come to a place of acceptance, then we can start the programme.

“At the end of the day, what the child needs the most is the intervention. If the child can get support as quickly as possible, in some cases the child can totally turn around,” she says.