Entering Their Imaginative World

In dealing with children with autism spectrum disorders, its all about relationship. These children are within a realm where they feel and acknowledge much differently than others. There has been much focus on trying to eliminate inescapable behaviors or to evoke singular responses in children which assuredly become rote and repetitive for them without context. One of the goals in aiding these children should be in helping them find meaning. In order to do this we must be willing to not look at the child as broken, unable to respond, or even unable to communicate. These children Do communicate, however they are not always able to manipulate their senses to chronicle in the typical ways of other children. As a result, they can become assuredly frustrated and trapped. The therapist must enter their imaginative world and learn to chronicle in their language.

Dr. Stanley Greenspan gives an example of a child who initially went to a psychologist who engaged the child in repetitively placing pegs in a board or trying to find beads underground under varied cups. This was supposed to be a measure of the child's brain and abilities but it proved ineffective. The child enduringly hurled the pegs to the floor. A distinct psychologist took a unique approach in having the mum share with the child in a series of interactions. First, the child began grabbing the nose of the mother. Rather than redirecting the child and seeking to have her refrain from the grabbing, the mum responded with a 'toot toot' noise and then allowed her to do it again responding with a new noise. The mum then gradually touched the nose of the child and the child to the amazement of the mum smiled and let out a noise, "mo mo". The child had assuredly communicated but in her own language. The mum and child had made a real connection. This showed to the psychologist that this child's cognitive development was within a normal range and here was a child who wanted to exert some control over her surroundings. Over time, the communication increased, and the mum was able to have 'pleasurable' discussions with her child that prior had never existed (Greenspan, The increase of the Mind, 1997, pg. 8-9)

Boys Growth Charts

Children with language difficulties need to have emotional and collective supports. Unless these are more fully developed, the language will be fragmented and lack meaning (Greenspan, pg. 32). Before language development can come, enhancing the insight of non-literal and non-verbal communications need to be worked upon. There are 6 main milestones for children: self regulation and interest in their surrounding world; intimacy; two way communication; complicated communication; emotional ideas; and emotional thinking. In Greenspan's floor time model the first goal is to encourage attention and intimacy which helps in the further development of the first two milestones. The parent will actively share in a period of play therapy involving their child in creative play allowing the child some direction over the procedure of the session and taking interest in their activities as well as providing encouraging feedback. Self-regulation becomes difficult for some children because sensory stimulation can be so extraordinary or their attention may range (Greenspan, necessary Partnership, pg. 8). Difficulties in intimacy occur because the child is not able to effectively read the cues being given. Often times the children will have an easier time with adult relationships because adults are more able to adjust their cues to the level of insight of the child whereas this does not always occur with peers. A part of reaching out to these children and guiding them in the intimacy milestone is to supply them opportunities to interact with peers and to have them be able to chronicle back what the other man is stating and feeling. Making use of collective stories and role plays can be helpful in aiding the child in insight the feelings of others as well as their own feelings. A collective story is a gismo used where a make believe dialogue is constructed and the child is asked to fill in the gaps. "A collective story is a story written to exact guidelines to chronicle a situation in terms of relevant cues and coarse responses (Gray & Granard, 1993). The use of comic strip conversations can also be employed. "A comic strip conversation is the genuine 'art of conversation'. This approach incorporates the use of uncomplicated drawings and color to elucidate an ongoing communication. This provides further hold to (children) who struggle to understand the quick replacement of information in a conversation (Gray, 1994). An advanced form of the collective story is what is termed the 'thinking story'. "Thinking stories demonstrate the range of possibilities as to what habitancy may be mental when they make inescapable statements, or when they display inescapable behaviors...Thinking stories succeed a specific, structured format, using photo symbols from Comic Strip Conversations to define and elucidate the abstract concepts covered in the story (Baron-Cohen, 1990, Dawson &Fernald, 1987). The man or therapist using the collective story can help guide the child straight through and the use of feelings charts can also be a beneficial aid. To reach the milestones of two way communication and complicated communication, it is prominent within the sessions that the parents have that they utilize a dialogue with the child, help guide them to use their face, emotions, hands, to transport their needs and desires. Encouraging the child's imagination and creativity will help in the development of the complicated communication as they begin to move towards qoute solving. Lastly, it is prominent to work on logical thought, being able to take the things they have learned from the parent's coaching and to assuredly be able to transport some insight and insight of the world.

In the play therapy sessions, it is prominent for the parent and/or therapist to actively participate. The purpose should not be to entertain the child, but to interact with the child. Seek to draw near to the child, but this should not be forced, allow the child to express themselves at their singular pace. Use lots of gesturing and cueing and become a part of their imaginative play, allow them to show and teach you something about their world. It is prominent to not just tolerate their feelings and assuredly not be dismissive of them, but allow the child to express their feelings openly being able to distinguish feelings from behavior. Don't be afraid to challenge the child in new skills, they will be eager to learn as long as the challenge is not forced. From time to time, you will notice that these children will become obsessed with routines or repetition, so in the play do something to break the disposition or repetition. If a child is repeating a inescapable topic or action, do something entirely distinct that will focus their attention elsewhere. Do not be repetitive in your directives and succeed a plan of rote learning, allow the child to discover and display what they do know. It is prominent to ask open ended questions, let the children elucidate to you. Find out what these children find meaning in, and seek to have them tell you why. Don't judge or value their answers, but be a listener. Help the child to brainstorm new ideas, and particularly when friction arises, let them be able to achieve some self assessment, sit as a partner as they manufacture adaptive responses and utilize them. Don't be afraid to allow the child to fail from time to time, they will learn and gain insight from their trial and error. When the child is expressing inescapable thoughts and feelings, help them to be able to label what it is they are expressing (Greenspan, necessary Partnership, pg. 20)

There are key collective behaviors as they chronicle to relationship building that should be addressed with the child who has been diagnosed with Asperger's syndrome. The first is entry skills. This refers to how the child joins a group of children and either or not they seek to comprise other children into their play. The therapist can help serve as a coach for entry skills and encourage scenarios where the child will have opportunities to practice the skill (Atwood, 1999) Next is assistance, either the child recognizes when to seek help from others or to supply help to others. collective stories can assuredly be utilized in this situation. An example of a collective story as given by Dr. Tony Attwood (1999) that applies to this skill is as follows: Sometimes children help me. They do this to be friendly. Yesterday, I missed three math problems. Amy put her arm nearby me and said, "Okay, Juanita" She was trying to help me feel better. On my first day of school, Billy showed me my desk. That was helpful. Children have helped me in other ways. Here is my list: I will try to say, Thank you! when children help me. an additional one example of a collective story is: My name is Juanita. Sometimes, children help me. Being helpful is a kindly thing to do. Many children like to be helped. I can learn to help other children. Sometimes, children will ask for help. man may ask, 'Do you what day it is today?' or 'Which page are we on?' or maybe something else. Answering that question is helpful. If I know the answer, I can acknowledge their question. If I do not know the answer, I may try to help that child find the answer. Sometimes, a child will move and look all around, either under their desk, in their desk, nearby their desk. They may be looking for something. I may help. I may say, "Can I help you find something?" There are other ways I can help. This is my list of ways I can help other children: Children like to be helpful (Atwood, 1999). For younger children the use of the Mr. Men stories (such as Mr. Nosy, Mr. Grumpy) by Roger Hargreaves can prove useful.

The other skills which need development comprise receiving and accepting compliments, accepting and receiving criticism, accepting suggestions, reciprocity and sharing, friction resolution, monitoring and listening, empathy, and studying to ending meaning how to supply closure to an interaction. For friction resolution skills I advise the use of Weeks's 8 fold model. In this model one first provides and sufficient atmosphere for the discussion and resolution of the conflict, elucidate perceptions, focus on needs, build shared inescapable power, look to the time to come and learn from the past, create options, manufacture doables, and make mutual advantage agreements (Weeks, 1992). The child diagnosed with Asperger's Syndrome will need singular coaching and hold in going straight through these steps.

Within the instruction principles is a great misunderstanding of Asperger's Syndrome. These children cannot be placed in an autism classroom as they are too high functioning. These children can be involving and some teachers and school administrators are afraid of taking the necessary steps to insure these children's success. Partial hospitalization becomes an easy out for the school districts. Teachers need to be able to build a relationship with the child and identify their strengths, being respectful of the child's personal space and boundaries and always speaking to the child in a calm and collected manner. "Teachers need to have a calm disposition, be predictable in their emotional reactions, flexible with their curriculum, and see the inescapable side of the child (Atwood, pg. 173) Some teachers see that these children will rock in their seats or move their hands or feet and look at these children as being disruptive in the class. The rocking behavior is a way that the child 'grounds' themselves, it is comforting for them, and is not a behavior to condemn the child for nor one that can or should be eradicated. If it appears to be a disruption, the teacher can supply a place for the child to be able to have a break until they feel they are more calm. School supervision must understand that for the Asperger's child that sensory stimuli can be very frustrating, and sometimes these children may need brief periods away from school that allow them to regain some emotional stability. Such absences should be written as proper in the Iep and should not be treated as truancy situations. The size of the classroom is illustrious for these children. "Open plan and noisy classrooms are best avoided. The children acknowledge well to a quiet, well-ordered class with an atmosphere of encouragement rather than criticism. Parents find that with some teachers the child thrives, while with others the year was a disaster for both parties. If the teacher and child are compatible, then this will be reflected in the attitude of other children in the class. If the teacher is supportive then the other children will amplify this approach. If they are necessary and would prefer the child were excluded, other children will adopt and express this attitude (Atwood, pg. 174). Once a child is in an proper environment with the necessary resources, this environment should be maintained. "Once parents have placed a school that provides the necessary resources, then it is prominent to assert consistency. Going to a new school means changing friends and the school not being aware of the child's abilities and history of thriving and unsuccessful strategies." Children with Asperger's syndrome may display an unsual gait and difficulties with motor skills and coordination. They may also have strangeness with sensory stimuli so it is prominent for the therapist to take note of distressing stimuli and help to limit these things within their environment as much as possible. Activities designed to work on motor skills and coordination can prove beneficial but notice should be taken as to not force a child or cause undue dissatisfaction if the child's abilities are impaired. Emotional coaching can prove sufficient for parents of the child with Asperger's syndrome. Emotional coaching involves seeking to see the expression of emotions as a time for intimacy and teaching, providing validation to the child's emotions, and helping the child to be able to label their emotions. The parent who is an emotion coach values the child's negative emotions as opportunities for intimacy; can be outpatient with the child when they are sad, angry or fearful; can identify triggers; does not tell the child how to feel; does not expect to have all the answers (Gottman, 1999). There has been some discussion of a link in the middle of gastrointestinal disorders and children with autism spectrum disorders (Wakefield, 1997) Some children with autism spectrum disorders may exhibit encopresis. The child should be regularly seen by a doctor if any qoute arises. The child should not be punished for occasions of encopresis or be made to feel embarrassed. As pediatric neurologist Fred A. Baughman has stated, autism is a blanket term as is cerebral palsy identifying a developmental health rather than a psychiatric issue. While those considered within the autism spectrum may display similar traits, there are diverse etiologies (Baughman, 2001). Some children with traumatic brain injury or epilepsy may display autistic traits. However, there can also be psychosocial reasons for the development of autistic traits. The term itself is very loosely used and at present the exact etiology is not fully known. I tend to look at autism as a inequity in perception, yet a normal variation. These children are not defective. As individuals may be left handed or right handed, this is a variation, but does not state that a left handed personel who is in the minority is somehow defective or 'abnormal'. Rather, because children with autism have a variance in their perception, this causes them to come into friction with the normal functoning and perceptions of society as a whole. They have unique strengths but may need dome extra aid in being able to navigate straight through what the rest of society typically perceives and how it interacts.

There are no medications that will cure autism and Asperger's syndrome. Some individuals have used varied medications in an attempt to control behaviors, however it must be realized that this is all that the medications are capable of doing is controlling a inescapable aspect of behavior by blunting inescapable brain functions. These medications all have serious risks. "Neuroleptics have their main impact by blunting the highest functions of the brain in the frontal lobes and the intimately associated basal ganglia. They can also impair the reticular activating or energizing principles of the brain. These impairments succeed in relative degrees of apathy, indifference, emotional blandness, conformity, and submissiveness, as well as a discount in all verbalizations, together with complaints or protests. It is no embellishment to call this succeed a chemical lobotomy...contrary to claims, neuroleptics have no exact effects on irrational ideas (delusions) or perceptions (hallucinations)." (Breggin, 1999) These medications also carry the risk of causing tardive dyskinesia or neuroleptic malignant syndrome. Tardive dyskinesia is permanent abnormal movements of the voluntary muscles. "Nms is characterized by severe abnormal movements, fever, sweating, unstable blood pressure and pulse, and impaired mental functioning. Delirium and coma can develop. Nms can be fatal...(Breggin, 1999) coarse side effects of neuroleptic medications as reported by the Physicians Desk Reference are abdominal pain, abnormal walk, agitation, aggression, anxiety, chest pain, constipation, coughing, decreased activity, diarrhea, dizziness, fever, headache, inability to sleep, increased dreaming, indigestion, involuntary movements, joint pain, lack of coordination, nasal inflammation, nausea, overactivity, rapid heartbeat, rash, reduced salivation, respiratory infection, sore throat, tremor, vomiting. The Ssri antidepressants' are also a coarse prescribed medication. These drugs can yield akathisia, mania, worsening of depression, obsessive compulsive like behaviors, and severe anxiety and agitation (International center for the Study of Psychiatry and psychology Newsletter, Summer 2002, pg. 15) The use of responsible psychosocial and relationship based approaches are far great than any short term advantage that neuroleptics may provide.

Scenarios to reflect upon- value each choice, what seems most appropriate? Joe is in class and his teacher is explaining a math assignment, Joe sits in his chair rocking back and forth incessantly. The teacher finds this disruptive.

The Tss intervenes by: A.verbally redirecting Joe to sit still and pay attention to what the teacher is saying

B.find a place within the room where Joe will not be a distraction to the teacher, allow him to rock if necessary, ask Joe to elucidate to you what instructions the teacher gave and insure his comprehension.

C.Place Joe in a time out until he agrees to stop rocking

Margaret has a singular interest in rock music and can give detailed descriptions of bands, songs, etc. Margaret is having an prominent conversation with her mother, but Margaret keeps getting side tracked wanting to talk about rock music. The Tss intervenes by:
A. Telling Margaret that later in the day they can listen to rock music together and discuss but presently she needs to listen to what her mum is stating

B.give Margaret a time out for not listening to her mother

C. Allow Margaret to continue discussing rock music and have her mum continue the conversation later

John is changing classrooms which often can be frustrating for him. There is a lot of noise and distraction in the hall and man accidentally bumps John in the hall. John becomes aggressive and begins pounding the lockers and cursing. He lunges at a boy who comes near him. The Tss intervenes by:

A.grabbing John's arms and instructing him verbally that he needs to stop

B. Retaining some distance from John, dialogue with him about what is frustrating him, ask him if you can accompany him to a quiet place to sit, offer him a drink, proceed to the classroom once hall is clear and John is more calm.

C. Tell John he will be sent to principal's office if he continues to be disruptive. Lead him to classroom

D. Allow John to continue to pound on lockers until he de-escalates himself

Eric goes to a store and sees a man buying a toy. Eric gets very close to the man and loudly exclaims, "What are you doing? Who are you buying that for?" The man appears startled and walks away. Eric appears hurt that the man would not acknowledge to him. The Tss intervenes by:

A. Explaining to Eric that his interaction was inappropriate and he needs to have proper boundaries.

B. Explaining that the man probably misunderstood Eric and not to feel bad, and coach Eric on how he could interact great in collective situations Tell the man that Eric has Asperger's syndrome and that he hurt Eric's feelings.

Valanti is frustrated and rather than speaking he clinches his fists, turns red, and begins stomping his feet. The Tss intervenes by:

A. Giving Valanti a time out

B. Take Valanti aside, allow him to vent, and discuss the feelings and why they were there, using a feelings chart if necessary.

C.Explain to Valanti that his outburst is inappropriate and he will receive a consequence.

Sample Floor Time Session (adapted from information in case,granted by Dr. Stanley Greenspan, Md and Dr. Serena Wieder PhD

Preparation: 1 to 5 minutes

*What is your child's mood and energy level?
*What is your mood and energy level?
*Remind yourself of your child's sensory preferences to help him find his sensory "comfort zone" while your floor time session.
*Is she more attentive to high or low pitched noises?
*What kinds of textures does he like to touch and be touched by?
*What kind of visual experiences attract her?
*What kind of movement is stimulating, soothing?
*What kinds of oral-motor performance manufacture his behavior?
*What is the child doing?
* How can I join in?

Interaction: 20 to 25 minutes

*Position yourself in front of your child.

*Use gestures, tone of voice, and body language to accentuate the emotion in what you say and do. Be animated.

*Talk less. Find ways to play that don't want words.

*When you do talk while play sessions, use language that is at your child's developmental level. If your child speaks in 2-3 word utterances, limit your own speech to 3-4 word utterances.

* Do less. To avoid extraordinary the child or dominating the activity, do only as much as the child is doing.

* Imitate the child's actions.

* succeed the child's lead regarding the "topic" for play. You can choose the topic at other times, but while floor time, let the child choose.

Fostering attention, engagement, intimacy

Follow the child's lead and join him. It does not matter what you do together as long as he initiates the move.

Treat everything your child does as intentional and purposeful. Attach meaning to (seemingly) meaningless behavior.

Join in perseverative play.

Do not interrupt or convert the field as long as child is interacting

Pursue delight over other behaviors; do not interrupt any pleasurable experience.

Creating and sustaining interaction in the face of avoidance Do not treat avoidance or "no" as rejection; persist in your pursuit.
Insist on a response--Any response (not just the one you are hoping for).
Play dumb or make the wrong move to provoke or hold an interaction.
Playfully interfere with what the child is doing.
Block fly routes, and turn the child's fly efforts into an interaction.

Entering Their Imaginative World- Intimate Developmental Instruction

As I begin therapy with children diagnosed with autism spectrum disorders, I initially focus with the parents on the strengths of their child while also obtaining information on their current level of functioning. I see the therapeutic attempt as needing to be collaborative and drive based to be successful. I encourage the parents to also become complicated in one on one interaction, being coaches to their child, as we tour the path to enhancement and progression in developmental milestones. I advise to the parents that they spend at least two 30 wee periods each week in one on one interaction such as Greenspan's floor time or a modification thereof. I soon begin to get to know the child (for those who are non-verbal, I will interact directly with them and allow them to take the lead and show me who they are and where their interests lie.) For others I begin to dialogue directly. I seek to identify areas that cause them distress such as transitions and what things may be triggers. From this, the time to come of sessions lies much in relationship building and in modeling and cueing as well as implementing some of the interventions as listed above to aid the child to manufacture a greater level of functonining all the while reassuring them the family that their child is not defective but has a unique method of perception that should be appreciated and that delays in development does not imply a unblemished halt to development.

Try to be as accepting of the child's anger and protests as you are of inescapable emotions. Remember that anger is often accompanied by eye contact, bodily contact, and purposeful interaction--the very behaviors you are trying to foster.

Entering Their Imaginative World