Speaking to some physiology students they gave me a few links to useful resources related to Autism:
The main point(s) I got from this NHS document were:
Autism in children
Autism can normally be diagnosed in children at around the age of two. However, it can be difficult to diagnose as the symptoms will often only become more noticeable as they get older.
See your GP if you notice any of the symptoms of ASD or if you’re concerned about your child’s development. You can discuss your concerns together in depth before deciding whether your child should be referred for a specialist assessment.
If your child is diagnosed with ASD, there will be many things to consider as a parent, including coping with daily life at home and choosing the right school.
They also showed me a journal related to the autism spectrum:
Supporting families at home: Good Autism Practise Journal
' In all cases, team members will meet with the primary care giver at home within a month from referral (this is usually the child’s mother, although fathers/partners and siblings may be involved in implementing the strategies with the child). They explain the team’s working methods, and identify with the family whether an intervention will be appropriate.
The worker assesses the child across settings – home, school, at short breaks or in the community – and liaises with family members and involved professionals, to identify the child’s cognitive level, sensory profile, skills, interests and difficulties. This is vital as there are no ‘off the shelf’ solutions. Even when children present with the same problem the underlying causes may be very different, and each intervention is individualised to address the child’s unique needs within their unique family context. '
'Case studies
The following two case studies are illustrative of the work the team carries out. The children’s names have been changed to protect their identities
Sally
Sally was 11 years old and lived at home with her mother, father, older brother and younger sister. She was taught within a specialist setting for children on the autism spectrum within a mainstream primary school. Sally was terrified of dogs and the situation had reached a level where she refused to go out with the family in case she saw a dog. This behaviour was limiting the family’s ability to do anything together: one parent would have to stay at home with Sally while the others went out.
Following the referral, the allocated Family Advisory Worker observed Sally in school, at home and out for a walk in the community. At school she used a whole day schedule (printed words on removable cards) which she checked and manipulated independently. School staff identified that her fear of dogs was affecting her ability to join in with school activities taking place in the community and that they had recently stopped attempting to include her in community-based activities as her extreme reaction to dogs put both her and other pupils in danger. At home Sally was generally very independent and did not need or want ‘help’ from her parents. Although she had good verbal skills she was unable to say why she was afraid of dogs.
The worker accompanied Sally and her mother on a walk in the park to see how she reacted to coming into contact with a dog. Sally walked next to her mother when there was no dog in sight but quickly became extremely distressed when she saw one. She tried to climb up her mother as the dog approached and wanted to be carried. When – due to Sally’s size and weight – this failed, she tried to run away from the dog and had to be restrained by her mother.
Intervention
The worker and Sally’s family identified that she needed to be taught more adaptive strategies to follow when she saw a dog, and that these should be supported visually. Before direct work with Sally began, the worker made a number of visual supports. These comprised:
a portable strip with four detachable images to show Sally what to do if she saw a dog. This would show Sally a strategy to use when she saw a dog and would help to lower her anxiety. It also gave the adult accompanying her something tangible they could give Sally to focus on.
detachable images (black and white line drawings with words beneath) that showed “Walk”, “See a dog”, “Hold hands with...” and “Keep walking”. Although Sally used a printed word schedule at school it was felt that, as her anxiety level was particularly high when in the presence of dogs, she would need more concrete and visually clear instructions the “Hold hands with...” card had a space for a photograph of whoever she was walking with. This would give Sally additional information at a time when her anxiety was at its most extreme.
Copies of all visual supports, with photos of the appropriate people (her mother and father for home, the classroom staff for school), were shared with school so that the visual supports could be used across all environments to ensure that the strategies used to help Sally were consistent.
The worker began by introducing the portable strip to Sally at home to ensure that she understood the information on it. She then went out for a walk with Sally and her mother. The visual support at this time indicated that, if she saw a dog, Sally should hold hands with the worker. The worker had pre-planned the walk with a dog-owning colleague, to ensure that Sally would come into contact with a dog. When the dog appeared the worker showed Sally the portable strip and she held the worker’s hand. However, as the dog came closer, Sally became very agitated and began to run (exciting the dog, which strained at its lead) and the worker was unable to keep hold of her.
Following this, the worker restructured the visual supports to show Sally “holding hands and standing still by....” as it was clear that expecting Sally to walk away was unrealistic. This strategy was tested on a second walk and proved much more successful. Following the introduction of this restructured visual support, Sally was encouraged to complete a number of walks both at home and school with different adults.
Outcome
The family are now able to go out together as Sally has a strategy she can use when she sees a dog and, as a result, can tolerate being near to them. The school are now able to take Sally out and she can again join in school- based community activities. Over time, the “Hold hands with...” card, with a photograph attached, has been superseded by a generic image of an adult and child holding hands, as Sally is able to follow this strategy with any adult she is walking with. '
There are many clear examples of how families can be helped with support from this team but this can also be applied to the therapy and other workers provided by the NHS and private health care.
'A range of support strategies
Choosing the right kinds of support for the individual child is important. The following list offers a wide variety of approaches which can be used according to the child’s needs.
Using visual aids
Children with an ASD often find it easier to understand the world about them through visual aids. Teachers can use a visual timetable showing times and simple drawings of the activities, so that the pupil knows exactly what they will be doing and when. This approach can be applied to all kinds of sequential processes. For a child at primary school who is particularly anxious about getting changed for PE, for example, a sequence of photos or illustrations of each stage of the process can be invaluable. The- visual aids can be laminated to make sure that they are robust and displayed where appropriate. Many schools use computer software packages to write out stories, descriptions and instructions in both words and symbols simultaneously. Other visual supports include written lists, objects and calendars which can help children understand sequence and predict what is to happen. Parents, too, may well value copies of the timetables so that they can help their children to be organised for the school day. For older pupils who wish to keep their visual supports discreetly, pasting their visual timetables into a school planner can be helpful, as can keeping pictorial reminders on a key ring in a pocket. Clocks or sandtimers can be a useful aid, too, for those who find it difficult managing their time. Please see our resource lists on pp28 for more information about useful resources.
The Picture Communication Exchange System (PECS)
PECS is a commonly used approach to teach children who have limited language. Teachers use pictures as symbols to teach children the names of different objects. Gradually a child is taught to exchange a picture for the object he or she wants, to construct simple sentences using the pictures, and indicate choices between various objects.
Social storiesTM
Children with an ASD who can read may be taught how to cope with different situations using the technique of social storiesTM, first developed by Carol Gray. Stories are written for the individual child, explaining in very clear and simple words and pictures, step by step, what will happen in situations where they may feel anxious and how they should cope with situations they find difficult. For instance, a social storyTM might be used to explain what a child should do on a bus journey or when they hear a fire alarm.
Comic strip conversations
Comic strip conversations assist children with autism to develop greater social understanding, by providing visual representations of the different levels of communication that take place in a conversation, using symbols, stick figure drawings and colour. By seeing the different elements of a conversation visually presented, some of the abstract aspects of social communication (such as recognising the feelings and intentions of others) are made more concrete and are therefore easier for the child to understand.
TEACCH (Treatment and Education of Autistic and related Communication handicapped Children)
This approach is widely used within special schools and can be adapted for use within a mainstream setting. It focuses on altering the environment and using visual supports, such as timetable and schedules, to help provide structure, reduce stress by making it clear what is to happen throughout the day, and improve understanding. Children are given clear instructions for every stage of an activity, usually presented in a visual way.
SPELL
The SPELL framework has been developed by The National Autistic Society’s schools and services to understand and respond to the needs of children and adults with autism. It recognises the individual and unique needs of each child and emphasises that all planning and intervention be organised on this basis. SPELL stands for Structure, Positive, Empathy, Low arousal, Links.
Structure makes the world a more predictable accessible and safer place and can aid personal autonomy and independence.
Positive approaches and expectations seek to establish and reinforce self confidence and self esteem by building on natural strengths, interest and abilities.
Empathy is essential to underpin any approach designed to develop communication and reduce anxiety.
The approaches and environment need to be low arousal: calm and ordered in such a way so as to reduce anxiety and aid concentration.
Strong links between the various components of the person’s life or therapeutic programme will promote and sustain essential consistency.
Distraction-free environment
Children with an ASD can benefit from working in a distraction-free environment. It may be possible for primary teachers, for example, to allocate an area of their classroom which can be kept as free from anything which may distract the pupil from their tasks, but where they may see their visual timetable. Subject teachers at secondary schools may like to find the best seating position in their classroom for a pupil with autism. In large schools, a quiet area available to pupils who have additional learning needs can be very beneficial.'
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