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Greenspan’s DIR Model for Autism: Part 1

September 20, 2009

For therapists and families to be effective in working with kids with autism, they should be able to do any methodology.

There is an alphabet soup of different methods to teach kids with autism – Applied Behavior Analysis (ABA); the Developmental, Individual Differences, Relationship-Based (DIR) Model; Relationship Development Intervention (RDI); Treatment and Education of Autistic and Communication – Handicapped Children (TEACCH), and others.

Regardless of which methodologies are used, programs need to have goals and targets and teach in such a way so that kids can generalize skills to apply what they have learned to a natural environment.  Teaching methods should also integrate academics and cognitive skills; emotional awareness and social skills; exercise, sports, and motor skills; along with spontaneous, imaginative, and creative play.  Skills should be taught in a meaningful way rather than a robotic, rote way.

Children need to develop a relationship with caregivers in order to learn.  The revolving door philosophy of bringing people in and out so that a child has had 100 caregivers by the time he is 10 does not work.  Stanley Greenspan says, “Emotion always come before behavior.  The child needs to enjoy relationships with parents, peers, and teachers in order to learn.”  Emotion is critical to brain development.  It’s more than “cute” when a child is engaged with a caregiver.  The child learns better.

I have been an advocate of Greenspan’s DIR method for the past few years.   The Interdisciplinary Council on Learning Disorders (www.icdl.com) says this about DIR.

DIR is a comprehensive, interdisciplinary approach that focuses on the emotional development of the child. It takes into account the child’s feelings, relationships with caregivers, developmental level and individual differences in a child’s ability to process and respond to sensory information.  It focuses on the child’s skills in all developmental areas, including social-emotional functioning, communication, thinking and learning, motor skills, body awareness, and attention.

The goal of treatment is to help the child master the healthy emotional milestones that were missed in his early development and that are critical to learning.  Building these foundations helps children overcome their symptoms more effectively than simply trying to change the symptoms alone.

Then it says this about Floortime:

Floortime, a vital element of the DIR/Floortime model, is a treatment method as well as a philosophy for interacting with children (and adults as well). Floortime involves meeting a child at his current developmental level, and building upon his particular set of strengths.  Floortime harnesses the power of a child’s motivation; following his lead, wooing him with warm but persistent attempts to engage his attention and tuning in to his interests and desires in interactions. Through Floortime, parents, child care providers, teachers and therapists help children climb the developmental ladder.  By entering into a child’s world, we can help him or her learn to relate in meaningful, spontaneous, flexible and warm ways.

Floortime is a component of DIR but not the same.  In Floortime, you follow the lead of the child.  In DIR, once kids move past the initial stages of the developmental ladder, you create programs that revolve around the child’s interests, in which he is emotionally engaged, with meaningful two-way interaction, customized toward his individual differences.  The kids don’t tell you what to do; you just do things that are meaningful to them.  Again, Floortime is only a subset of DIR.  In the lower developmental levels of DIR (Floortime), you follow the child’s lead (but even then that means you follow and join what the child is interested in – the child doesn’t tell you what to do), and in the higher levels there are more structured, therapist or parent-led programs.

Two and a half years ago, I wrote on my website at http://www.coachmike.net/autism-faq.php (see #4) a little about DIR and Floortime, as well as a summary of Applied Behavior Analysis (ABA).

I combine elements of Applied Behavior Analysis (ABA) as well as the Developmental, Individual-Difference, Relationship (DIR) based method. I believe a combination of ABA and DIR methods is optimal because ABA provides step-by-step instruction while DIR focuses on relationships, emotions and interests. Children need both structure and meaning when they learn.

ABA is used to teach academic, communication, problem solving, behavioral, social, play, and other skills by breaking tasks down into small steps and practicing drills. ABA also uses positive reinforcement and just as much prompting as is necessary. Inappropriate behaviors may be phased out by redirecting to target activities rather than drawing more attention to those behaviors. Antecedents, behaviors, and consequences are tracked to try to determine the reasons behind behaviors and implement appropriate interventions. However, some behaviors may be accommodations children need to manage their body or sensory difficulties. Therefore, I focus on building skills more so than reducing behaviors.

The DIR method focuses on the emotional development of the child. It takes into account the child’s feelings, relationships and individual differences. DIR involves following the child’s lead and enables the child to learn by doing what he or she likes to do in a fun and meaningful way. According to ICDL.org, “DIR focuses on the child’s skills in all developmental areas, including social-emotional functioning, communication, thinking and learning, motor skills, body awareness and attention.” The DIR method can also help a child generalize skills initially learned through drills.

Part of the DIR model includes Floortime, which is based on working with a child at his or her current developmental level, and building upon strengths and interests in a way that is meaningful to the child, rather than just focusing on surface behaviors and drills that don’t always generalize into life skills. Floortime can be especially effective during periods when a child needs more play and less work.

5.     Which is better – ABA or the DIR model?

In my opinion, this question is kind of like asking, “Which is better in football – running the ball or passing the ball?” or “Which is better in basketball – a zone defense or man to man?” They’re both necessary in different situations, and a balance of both may be most effective. For example, you can do repetitive drills broken down into small steps based on the child’s individual differences, interests and relationships, making sure to incorporate social skills and emotions.

In doing so, children can learn valuable skills such as sequencing the steps needed to complete a task. Children with autism benefit from structure, but they will be more engaged if the drill involves something in which they are emotionally invested. The DIR model is harder to quantify than ABA, but DIR is built on relationships, spontaneity and interaction. Children are not robots, and drills can’t be done in a vacuum.

For example, you can teach a child who is obsessed with a particular toy communication and problem solving skills in the following way: Hide the toy in one of your hands and get the child to reach for it and choose which hand it is in. Then you can do the same thing by holding the toy behind your back, or placing it near your face to establish eye contact. Subsequent steps may include getting the child to make sounds or use speech if possible to request the toy. The toy is used as a reward. This example is based on one in Engaging Autism by Dr. Stanley Greenspan.

For the rest of the FAQs on my website, see www.coachmike.net.

Lately, it seems that RDI has taken off as the method of choice.  I can’t really see how RDI is much different than DIR, except maybe that the order of the letters sounds a little bit more catchy.  If anything, RDI seems like an implementation of DIR.  However, this summary from Chicago Floortime Families points out some differences as well as many similarities.

According to about.com (I went there because the RDI website at http://www.rdiconnect.com/ doesn’t do a good job of describing RDI), children can develop the following through RDI:

  • Dramatic improvement in meaningful communication,
  • Desire and skills to share their experiences with others,
  • Genuine curiosity and enthusiasm for other people,
  • Ability to adapt easily and “go with the flow,”
  • Amazing increase in the initiation of joint attention,
  • Powerful improvement in perspective taking and theory of mind,
  • Dramatically increased desire to seek out and interact with peers.

This looks a lot like DIR to me.  In any case, whether it’s DIR, RDI, or you want to create a new acronym such as IRD or IDR, the goals of each system are the same.

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Greenspan’s DIR Model for Autism: Part 2

September 20, 2009

I decided to take some of the most important passages from “Engaging Autism” by Stanley Greenspan and Serena Wieder, with other quotes paraphrased.  These are the lines from the book that I underlined when I read the book three years ago.  I did the same for the John Gottman relationship books on a blog a while back.  Of course, like Rodney Dangerfield said in “Back to School,” the guy underlining the pages “could have been an idiot.”  So with that said, here goes:

Quotes from Stanley Greenspan’s “Engaging Autism” (I bold parts that I think are most important, and I divided the quotes into categories where I thought they fit best).

Developmental vs. Behavioral Approaches

  • Many programs that focus…on symptoms or behaviors rely on the troubling assumption that many children with ASD cannot ever acquire skills for truly intimate relating, empathy, and creative problem solving.  The DIR model focuses on the underlying deficits that lead to symptoms.

  • Schools tend to be very structured and to put a high priority on compliance and limit setting, rather than on engaging, interacting, problem-solving, and thinking creatively and logically.
  • The behavioral model led to modest educational gains and little or no social or emotional benefits.
  • The old way:  children could learn social behaviors in a scripted, memorized way, but not engage in spontaneous and creative social interactions and thinking.
  • With the new developmental approaches, we see it as a continuum on which all children can become warm and related and purposeful.
  • We now understand that the lines of early development are interrelated.  Rather than assessing language skills, motor skills, and social-emotional skills separately, we should look at how well these abilities are integrated, how they work together as a whole.
  • An example of a non-DIR approach:  isolated skills, such as matching shapes, rather than essential developmental building blocks.
  • The DIR model shows how to use a range of interventions in a truly integrated manner.

  • Parents and clinicians need not make a Solomon’s choice between relationships on one hand and cognitive and language skills on the other.  Cognition, language, and social-emotional development all stem from the same foundation.

  • DIR is organized by asking:  What are the problem behaviors?  How is the child doing on the fundamentals of relating, thinking, and communicating?  How is the child doing on her processing capacities, and what are the contributing factors (including biomedical challenges) affecting these capacities?  What experiences work and don’t work to help the child, and how capable is the family of doing the things that work?

Don’t have a Ceiling

  • Progress comes from getting the child to take the initiative.  The biggest mistake is telling the child what to do to provoke a set response, rather than challenging her to take the initiative or to solve a problem with you.

  • It’s just as important to work with children when they’re at peak performance as when they’re struggling, because then we help them advance developmentally and master higher levels all the time.
  • Never assume a ceiling on a child’s abilities.  Always assume you can get to one more level, and after that, one more level.
  • The child may have a disorder or a set of problems, but he is not the disorder.  He is a human being with real feelings, real desires, and real wishes.
  • The brain develops into the fifties and sixties, so it’s never too late.

Learning and Language through Emotions, Engagement, and Relationships

  • Mastery of the early stages of emotional interaction is associated with language and thinking skills.
  • Language, cognition, and mathematical and quantity concepts are all learned through emotionally significant interactive experiences and relationships.  Emotions enable us to learn.
  • Emotion is critical for many elements of language.
  • When engaged, children have a desire to communicate.
  • At the second level are the ongoing and consistent relationships that every child requires for emotional and cognitive competency.  Children with ASD need even more warm, consistent caregiving than do typically developing children.  Almost all human learning occurs in relationships, which must foster warmth, intimacy, and pleasure.
  • Use words meaningfully through emotions and pretend play rather than by rote.
  • The goal is to have all of the emotional experiences of life expressed through circles of emotional interaction.
  • Turn the activity into shared interaction.
  • The ability to love deeply is present in children with ASD, whether or not it can be easily expressed.
  • Children should be encouraged to express negative feelings.  Don’t take the child’s expressions of negative feelings personally, but respond sympathetically so he doesn’t get the idea that expressing his feelings is dangerous.
  • Emotion always come before behavior.  The child needs to enjoy relationships with parents, peers, and teachers in order to learn.

  • Many adults who had ASD and other special needs as children achieve a high level of empathy or enter the helping professions, because often they had to struggle more with challenges or feelings of disappointment than their peers did.  (My comment – this proves that kids with autism can learn empathy.)
  • We believe the primary problem in individuals with ASD is a biological difficulty in connecting emotion to motor actions and later to symbols.  Emotions link different types of mental functioning.

Other Language Skills

  • It’s better for children to use single words interactively with meaning than to recite whole sentences or paragraphs they have memorized.
  • Children with auditory processing challenges especially need to hear the rhythm of a voice.  Repeat what you say, and emphasize it.
  • Since John’s main form of communication related to getting fed, mother played a little dumb to extend those moments with John was negotiating for some of his favorite foods.
  • Help the child connect ideas by pretending you don’t understand.

  • Say something like, “I went to the zoo and I saw a _______.”  Have the child fill in the blank.  Or, “He has four legs and barks.  He is a ______.”
  • Ask a child what he enjoyed most at school, and why?  (Keep in mind many of these suggestions will have to be adapted for the level of the child.  This one wouldn’t work for a child unable to communicate that level yet.)
  • Listen to audiotapes of stories in the car.

Family Involvement

  • Not enough time is spent watching the child interact with a parent or other trusted caregiver.  In many evaluations, children are separated from parents and challenged to perform various types of developmental tests in a way that fails to take into account the child’s individual differences.  The child becomes stressed and confused.  To make a proper diagnosis, a practitioner also has to see children at their very best.
  • The clinician may see the child for a couple of hours, but parents see the child for hours and hours every single day for years.
  • However gifted a particular therapist is, what really counts is what is done every single day, for hours a day, with a child.
  • The key is to have fun together.
  • A child’s progress with a DIR/Floortime program requires parents who are emotionally very available.
  • If you don’t pull the sibling into the family challenge, the sibling feels excluded.
  • Siblings and peers can help a great deal.
  • In general, it’s most effective for the child’s therapeutic team – including parents, educators, coordinator, and specific therapists – to meet regularly to design goals for the program.

Floortime:  Following the Child’s Lead

  • Observe what kinds of interactions bring the child pleasure.
  • Follow the child’s lead, regardless of where his interests lie.  That give us a clue about what he finds important.
  • Often we look for a way to reach a child – the magic key that will unlock the hidden door – when all the while the child is showing what he needs by his actions and the way he’s processing what comes his way.  We need to observe what children are doing to help themselves in the moment and then figure out how to meet them there.
  • We build on the child’s interest to help him move up the ladder of shared attention, engagement, two-way communication, shared problem solving, and creative and logical use of ideas.  That requires not just following the child’s lead but also challenging him.  So we don’t mean simply copying or imitating the child.  We mean taking the child’s cue in order to build new interactions and experiences.
  • The idea is to go with the flow but without giving into the child’s agenda.
  • In Floortime, why do you follow the child’s lead?  A child’s interests are the window to her emotional and intellectual life.
  • Always challenge the child to initiate.

Oral-Motor Skills

  • Some children have oral-motor problems that make it hard for them to move their tongue and the muscles in their mouth in order to speak.  Some children with both oral-motor problems may appear to have cognitive disabilities and to lack social skills when in fact they are limited in expressing their abilities by their motor impairments.

  • The teacher can play little imitative games, starting with sounds the child can make, with the child and teacher looking in a mirror together so the child can imitate the way the teacher’s mouth moves.

Sensory-Motor Skills

  • Orienting kids in space can help them with postural control, which helps them organize their nervous system, which makes it easier to get interaction.  One example is walking on a balance beam.

  • To help children be comfortable, caregivers must learn which sensations help children become calm and regulated, which ones overwhelm them, and which don’t pull them in enough.
  • The level of a child’s motor planning skills must also be gauged.  The best way to do this is by watching the child play.

Social Skills and Play Dates

  • We always recommend that kids have at least four playdates a week, so that their main source of companionship begins shifting from parents to peers…Mommy is still important for security, warmth, and problem solving, but not for going out and riding bikes together.

  • If we try to teach logical thinking to a child who is not yet able to engage in reciprocal social interactions, we are trying to build the upper story of a house on a very weak foundation.

  • A child who learns how to be social in fun and emotionally engaging learning environments at home will want to be social and will be able to do it at school or at home, because he has generalized what he has learned.
  • Teach with images, action, and drama.
  • Children with ASD often take everything literally.  One of the most effective activities is pretend or imaginative play.  Encourage role play and play with puppets.
  • They need opportunities for playing and communicating with peers.  It’s important for children to learn to use words and gestures and develop relationships with peers at the same time they are learning to do these with adults.  If they wait, this learning will be more difficult later on.
  • We have never worked with a child or adult who didn’t have a desire to relate to others.

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Use Play Dates to Foster Social Skills in Children with Autism

August 22, 2009

The biggest disappointment I’ve had in working with children with autism is the fact that many of their parents are so hypocritical when it comes to play dates.

Play dates are structured play sessions between two or more children.  They are done because kids with autism have a very hard time learning the social skills that come naturally to most children.  Play dates are very beneficial because children learn skills such as taking turns, sharing, communicating both verbally and through body language, and playing sports and board games.  They learn spontaneous play, which in turn improves the ability to learn.  They learn how to think on the fly and practice imaginative play, which helps with kids who only think concretely and not abstractly.  They develop a sense of humor, which does the same thing.  In fact, spontaneous and imaginative play can help kids generalize skills across different people and environments (the inability to generalize is a huge problem in autism.  Kids may be able to learn something at a certain desk with a certain instructor, but may not be able to do the same thing elsewhere with someone else).  Play dates (along with sports, exercise, and other motor skill practice) can help make kids improve their cognitive learning.

Anyway, the problem is that many parents only want to have their children play with kids who are “higher functioning” than their own kids.  Yet they refuse to allow kids who they believe are “lower functioning” to play with their kids for fear that their kids might not learn as much or might pick up bad habits.  In short, the parents are “stuck up” about their kids.

Parents:  you are not making a major commitment for the future by trying out a play date.  Try it, and if you don’t think it’s a good fit you don’t have to continue for a long period of time, but be open-minded.  Sometimes I think you’re more autistic than your children.  You only want to do the same things over and over and refuse to try anything new.   When I see this attitude, it makes me so ready to move onto the next career, whatever that will be.

I’ve heard parents say, “Johnny doesn’t want (or need) friends.  He has his brother.”  Be careful of saying, “Johnny like this but he doesn’t like that.”  So you’ve decided at this young age what he likes and doesn’t like for the rest of his life?  Why don’t you want him to have play dates?  Do you want him all for yourself?  Is it codependency?  Is it that there are so many other more important things, that you want to get those done first?  Is it because you are afraid of failure, and a child should only do something if it is 100% successful, otherwise it’s not worth trying?  Is it because you’re lazy?  Are you afraid the child might cry?  Is it because you just want to hand over big checks to therapists and then let them handle everything so you can be done with it?  Is your child better than other kids?  Whatever it is, it’s not right.

I’ve even known of a case in which a parent didn’t want his child to play with a particular child who was perceived to be lower functioning, even though his child clearly wanted to play with this child and was very distraught about it.  Try explaining that to the child.

The level of hypocrisy is amazing.  I’ve seen parents almost cry because typical children don’t want to play with their kids.  Then when their children take a leap forward, they themselves refuse to have their children play with kids who may be at a slightly lower level than them in certain areas.

Here’s an example of how a child who may have slightly higher skills in certain areas can still benefit from playing with children who may have slightly lower skills.  Child A sees that Child B gets upset easily.  Child A can learn to comfort Child B and say, “I hope you feel better.”  Then Child A can learn empathy.  Child A can also learn leadership skills.  And how about having fun?  You focus on things that both of them can do well, and maybe even more of the activities that the lower functioning child can do well.

I don’t mean to be too negative.  I even once met a parent who was neither a hypocrite about play dates, nor held her kids back from having them.  The reason I write this is that I have facilitated many play dates – over 100 – and the vast majority have worked out great, and the few parts of play dates that haven’t worked out great still help prepare kids for life’s ups and downs.

Be open to trying new things and breaking out of the structure the way things currently are.  Otherwise, you’re just going to get the same results you’ve always gotten.  Reading a social story is nice.  Participating in a social story is even better.

Note – I know the above may sound harsh.  Most of the parents I’ve met do a good job of setting up play dates for their kids, and most of them do want to see their kids have fun. I know of at least one parent for whom all I did for a year for her child was facilitate play dates, and on top of that, she had an additional playgroup.  Very impressive.

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Lessons Learned from Autism Therapy

August 22, 2009

In my experience working with children with autism (see www.coachmike.net), I’ve come up with several lessons learned based on observations I’ve made over the years.  I list ten of them here, focusing on the management of home therapeutic programs.  I write this with the understanding that it is a monumental task to raise kids with autism and I usually only work with them for a maximum of 3-hour shifts at a time.  In other words, it’s easy for me to say.  Maybe I’m like the sportsradio caller who sits on the sidelines but criticizes the players.  Still, when I see the same mistakes being made over and over, I feel a responsibility to mention them.

1.  Parents refusing to have their children do play dates with other children. Some parents only want their children to do play dates with higher functioning kids, which is a little hypocritical because they won’t have them do play dates with lower functioning kids.  Also, some parents say, “Johnny doesn’t want friends.  He already has his brother.”  Or they are afraid to take a risk that something will go wrong.  Sometimes, it seems they are more autistic than the kids themselves based on their unwillingness to take risks and try something new.

2.  There is a lack of coordination between schools and home programs. The responsibility lies with the school, the home program, and the parents to ensure that there is enough coordination.  Without that, each side won’t know what the other is doing.  I’ve seen situations where the school doesn’t believe what the child has done at home.  I told a teacher, “But his father says he can do this.”  And the teacher replied, “I don’t believe him.”  (Use videotape to prove it to them!)  I’ve even seen a lack of coordination between certain aspects of the home program.  You wouldn’t hire two journalists to write an article about the same person without sharing and comparing notes, even if they were writing about different aspects of the person, and it’s even more important that everyone is on the same page in working with kids with autism.

3.  Therapists are shuffled in and out and there is a lack of continuity. In some cases, by the time a child is 10, he has been to several different schools, had several different home programs, and had turnover within each program so he has worked with more than 50 teachers and therapists.  It is not good for children to get attached to therapists and then have them taken away from them, because it teaches children that people are dispensable and interchangeable.  It’s also not good for the children psychologically to have people constantly shuffled in and out and taken away from them because they may develop problems in the future related to that.

4.  Giving too much power to the head of a home program. I observed one situation in which the head of the program wouldn’t let the family go on vacation when they wanted because the timing wasn’t right.  The parents should be the bosses. The organizations providing therapy are working for the parents – not the other way around.

5.  Not holding the head of home programs accountable enough.  It is tempting for parents to say, “I’m busy enough already,” and hand over the reins to the head of a home program and give them complete power.  However, parents need to periodically check up on the status of the program to see how much progress is being made and to make sure they agree with the strategies and subject matter being covered.  (Dads:  some of you have graduate degrees from Ivy League universities.  That’s nice.  Now could you possibly consider making some suggestions about your children’s programs? – you can’t even make any suggestions or any input about your child’s program?  Let me get this straight – you’re intimidated by someone half your age who has a couple years experience with kids?  You’d rather just hand over the money and not even know what is going on?)

6.  Making the child the King of the Household. A child has a disability, so parents feel sorry for him, letting him get away with bad behavior, and excusing him from acting appropriately.  Congratulations.  You are on your way to creating a monster who becomes the King of the Household.  You might as well start fitting the crown and the throne now.  On the bright side, everyone knows who rules the place.

7.  Giving up. It’s true that the early developmental years are the best for teaching children, but kids, and adults for that matter, can continue to learn throughout life.  Occasionally, parents focus so much on reducing behaviors and ensuring that kids are happy that they don’t push the kids to learn enough.  How many adults are thankful now that their parents pushed them to learn when they were younger instead of just giving into their gratifications at the time?  You wouldn’t allow your neurotypical son to say, “No! I don’t want to do math!” and get away with it, would you?

8.  Talking about the child in front of him or her. If you’re going to do this, make it positive.  Too often, parents (or teachers, therapists, or others) talk about a child in front of him as if he is not there.  “Johnny has a lot of problems learning math, and I’m afraid he will never be able to catch up.  He’s better at reading, but at math he’s hopeless.”  What if a child hears some variation of that once a week for ten years?  Also, many kids with autism have very keen hearing, so they may be taking in everything that you are saying.  We already understand that a lot of kids understand more than it appears.  Don’t have meetings about the child in front of him either because then he will get the impression that there is something wrong with him that has to be fixed.

9.  Believing your doctor is infallible. It can be dangerous to just listen to doctors without doing your own research.  The internet should be a useful tool for you to find up to date information.  Check out forums on specific topics written by parents who pool their experience rather than blindly trusting someone who sees your kid an hour and a half per year.  But instead of finding things out for themselves, as crazy as it sounds, I believe that some parents would rather do something that is accepted by the medical community that will not help their kids, rather than do something that may not necessarily be accepted that may help their kids. Author Lynn Hamilton put it this way:  “Stop seeing the doctor as the ultimate authority and to start viewing him or her as a member of their board of advisors…Ultimately, we are the ones who make the final decisions on what is best for our children.”

10.  Not putting enough attention into Emotion Coaching.  I’ve seen a few situations in which enough attention was paid to handling emotions, but the subject usually gets lost in the shuffle, which is strange because kids with autism usually are notoriously bad at identifying, understanding, and regulating emotions.  Kids should understand that it is normal to feel upset and that there are strategies they can use to calm down.  They need to understand the concept of empathy, or theory of mind.  The author and psychiatrist John Gottman says that emotional intelligence is a predictor of a child’s success later in life.  We’ve all met highly intelligent people who cannot deal successfully with other people.  I recommend Gottman’s book, “Raising an Emotionally Intelligent Child.”  Connected to this idea is the need to teach kids to say “please” and “thank you,” rather than ignore manners because other things are “more important.”  Otherwise, see #6 above.

11.  Parents crossing boundaries and getting too close to therapists and vice-versa.

I may sound critical and negative to some, but I’ve been fortunate to see most parents do an amazing job with their kids with autism.  I’m just pointing out patterns that I’ve seen many times that it would be nice not to repeat.  As I say on my website, www.coachmike.net, I don’t have my own children but sometimes you can benefit from hearing something from an observer.  Coaches are usually not as good as the actual players.  Do you think New England Patriots Coach Bill Belichick was as good as any of the 50 football players he coaches?  It doesn’t mean he can’t coach them.  As for me, I know I have the potential to be a great father, but I won’t take anything for granted and I will be the first one in a parenting course because I don’t think you can ever learn too much.

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Summary: “Raising the Emotionally Intelligent Child” by John Gottman

August 22, 2009

I think it’s critical to teach kids about emotions early and often, especially kids with autism, who usually have a hard time identifying, understanding, expressing, and handling their emotions.  So here I summarize notes from John Gottman’s book, “Raising the Emotionally Intelligent Child.”

  • Parents need to make the best use of the golden moments they have with their children, taking a purposeful and active role.
  • How parents interact with their kids when emotions run hot is key.
  • It’s good for kids to be able to regulate their emotional states.
  • Parents should offer their children empathy and help them to cope with negative feelings.
  • Good parenting is based on empathy and understanding.
  • Even more than IQ, your emotional awareness and ability determines your success and happiness.  For kids, it means controlling impulses, delaying gratification, motivating themselves, reading other people’s social cues, and coping with ups and downs.
  • You can say, “I think I know how you feel.”
    • Become aware of the child’s emotion
    • Recognize the emotion as an opportunity for intimacy and teaching
    • Listen empathetically, validating the child’s feelings
    • Help the child find words to label the emotion he is having
  • Don’t be harsh, critical, or dismissing of your child’s emotions.
  • See things from the child’s perspective.
  • The emotion coach can tolerate spending time with a sad, angry, or fearful child.
  • Confront your child’s sadness head on.  How do you feel?  Are you kind of sad?
  • Dismissing parents think children shouldn’t be sad.  They focus on the behavior rather than the emotion.
  • Sad children don’t always understand how to comfort and calm themselves.
  • Talk to children about their feelings.
  • Listen to their frustration and tell them it’s natural to feel letdown.  Validate them.

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Eye Contact: Overrated and Misunderstood?

August 6, 2009

There is a huge misconception that if a person doesn’t look someone else in the eyes, it means that that person is not being honest or trustworthy.   There is nothing inherent about looking someone in the eye that indicates honesty.  Different cultures have different norms and social morays.

People from countries such as China and Peru do not normally look people in the eyes as part of their culture.  So for people to assume that when people don’t look them in the eyes, they are telling lies, that is obviously not always the case.

Another case in which this old belief doesn’t hold true is for people with autism.  For a variety of reasons – looking someone in the eyes can be too much stimuli or too overwhelming, listening and looking at the same time may be too hard because of sensory overload, or social skills such as understanding what people do in a particular culture may not come naturally – people with autism often have a hard time looking others in the eyes.  Here’s one explanation of how some people with autism comprehend spoken language: http://www.aspieweb.net/video-why-autistic-people-dont-look-into-eyes.

If you want to find out if someone is telling the truth or not, go to www.lyintamer.com.  Janine Driver is one of the authorities on the subject.  Rather than use eye contact or whether someone touches his or her face as an indicator of truth, establish a norm for the person’s style of speaking and body language,and then see if the person talks or acts differently than they usually do.  That can be a better tipoff on honesty than whether a person is looking you in the eye or not.

In fact, the idea that there is a correlation between eye contact and “truthiness,” as Stephen Colbert would say, has been around so long that those who wish to beat the system have used that as a way to say, “See, I’m telling you the truth.”  One time an ex-boss of mine looked me in the eyes nonstop without any breaks.  Instead of thinking he was telling me the truth because of the nonstop eye contact, I perceived it as him intending for me to perceive that he was telling the truth.  If anything, it is awkward to constantly look someone in the eye without any breaks.

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Sports for Children with Autism

July 23, 2009

There was a good article in the Washington Post yesterday about a boy with autism who swims on a local swim team.  Kids with autism can benefit a lot from playing sports, as can their neurotypical peers from having them on the teams.  Swimming is one of the better sports for kids with autism because it is both individual, without a lot of complex requirements, yet still social in that kids are still part of a team.

Participating in sports can help kids with autism and other disabilities in many ways.  Sports give kids with disabilities confidence, improve socialization, get more oxygen to the brain, improve coordination, help them stay in shape, help them sleep better, improve cognitive function by improving proprioception (the body’s sense of where it is in space), and reduce inappropriate behaviors.  Improvements in fine and gross motor skills often go hand in hand with improvements in academic and cognitive function.  Certain exercises can relax kids and even help align both hemispheres of the brain.  And of course, sports are also a lot of fun.

Kids with autism often like swimming, trampoline, and swinging.  This gives us clues on what kind of sensory input they need.  What is the best sport for children with autism?  I tried to answer the question a couple of years ago at http://www.coachmike.net/autism-faq.php#12.  I think the real answer is, “Whatever they like best.”  In order to find out whatever they like best, we need to get rid of our preconceived notions and expose them to as many athletic opportunities as possible.  I learned this after coaching a child in soccer a few years ago who ultimately ended up playing hockey.  I never would have thought hockey would be a great sport for kids with autism because of the need to skate and handle a stick simultaneously, but it turns out that it can be great, and it just goes to show that we shouldn’t put limitations on anyone.

Sports can be more effective for kids with disabilities when they are mixed in with academics and social skills.  You can do a half hour of sports followed by a half hour of schoolwork, followed by a half hour of social skills.  Each area helps the child generalize and build on the previous one. Sometimes people make the mistake, though well intentioned, of segregating each activity to the point where each one is facilitated by different specialists who, worst-case scenario, don’t coordinate and communicate with each other.  In any case, each activity should transition and relate to the others, and ideally, you can do some academic work while moving at the same time.  One example is to play catch or jump on a trampoline while answering questions.  This helps with sensory integration.  Yoga is also great for balance and relaxation, and deep breathing and meditation exercises can help improve the attention spans of children and reduce unwanted behaviors at the same time.

For a high functioning child, you can have him or her play in a league with typical peers, preferably a couple of years younger than the child who has autism.  The child has a “shadow” who helps integrate him or her with the other children athletically and socially.  I’ve facilitated in this way, and also coached Special Olympics soccer, and both can be great depending on the situation.  See www.soccerideas.net for ideas on drills.  It’s the same concept as in school – sometimes it’s best for kids to be mainstreamed into the typical school environment, and other times it’s best for them to be in a self-contained (special education) classroom, and often the best of both worlds is a combination of both, depending on the situation.

Exercises are great, but it’s best to do ones that are meaningful in the context of sports, so that children can eventually be part of a team, or at least play in impromptu games after school, or even use imagination to make up their own games.  It’s how kids learn best – not just sitting at a desk doing work, but getting along with others, being spontaneous, thinking on the fly.

A lot of people are familiar with the amazing story of Jason McElwain, an autistic teenager who scored 6 three-point baskets for his high school team a few years ago.  This type of success doesn’t happen a lot, but it would never happen if too many limitations are put on children who have autism and other disabilities who want to play sports.

I’d like to add one other thing.  While parents shouldn’t push their kids too hard into sports, they should expose them to sports and in some cases kids may need a nudge.  You wouldn’t tell your child who says, “I don’t want to do math” that it’s ok to avoid homework just because he or she doesn’t want to do it.  Math is necessary and good for kids.  Sports may be good for them as well, so don’t be so quick to say, “He doesn’t want to do it.”  In any case, it’s better to try something new that to do the same things over and over.  Sometimes I think parents are more autistic than the kids themselves – not willing to try anything new, just doing the same old x number of hours of therapy sitting at a desk in a vacuum.  And playing sports is certainly better than sitting inside and watching TV.

Ok, that reminds me, I have one other thing to add.  Today, a lot of kids play video games, and one video game that can be beneficial is the Nintendo Wii, which has simulated sports that can create an interest in real sports (tennis, bowling, baseball), as well as fitness (yoga, exercises, and running).

For people in the Bethesda/Montgomery County, MD/Washington, DC areas, there are several sports-related opportunities for children with autism.

  • Kids Enjoy Exercise Now (KEEN, www.keenusa.org) is a free, volunteer-run sports program for kids with disabilities.  There is a waiting list that was up to a year long the last time I checked, but they don’t turn anyone away unless they are over 21.  KEEN has a general sports program, a swim program, a music program, and a Teen Club for higher functioning children to do outings.  KEEN has chapters in Bethesda, Washington, DC, and several more across the country, and even a few in England, where KEEN began.
  • Sports Plus, based in Germantown, MD, has sports leagues for kids with high functioning autism (www.playsportsplus.org).
  • Fitness for Health in Rockville has some excellent equipment and specializes in one on one training sessions.  See http://www.fitnessforhealth.org/.
  • Special Olympics provides sports for not only children but also adults with disabilities: http://www.somdmontgomery.org/.  The Special Olympics national website is http://www.specialolympics.org/.
  • There are a few youth hockey programs in the area such as the Montgomery Cheetahs (www.montgomerycheetahs.org).

Elsewhere, check with your local schools and governments, or search the web to see what is out there.

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The Daily Show: Samantha, Bee Nice

July 15, 2009

I love the Daily Show but a couple of weeks ago Samantha Bee was making a joke about the House of Representatives, saying, “They eat paste and wear a helmet.  It’s the one that likes bright colors and hates loud noises.  I’m saying that they’re dumb.”

I don’t get offended too easily, but this is inappropriate and I would think very insulting to people with disabilities.  Here are a couple of examples:  Some people may need to wear helmets because they are prone to seizures.  And certain children and adults with autism may have very sensitive hearing so they hear things much more loudly than most people do, so it’s not their fault if they are startled by loud noises.

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Coachmike.net and Autism

May 22, 2009

This table shows what types of therapies I do for children with autism compared with some other providers.  I currently have spots available for toddlers and kindergarteners for playdates and other activities during the day.  See www.coachmike.net for more information.

  Area of Instruction or Therapeutic Intervention
  Cognitive Skills and Academics using ABA, VBA, or other techniques Playdate Facilitation Understanding and Handling Emotions Sports, Exercise, Motor Skills, Coordination Trips in the Community
Coach Mike Yes – Great Results Yes Yes Yes Yes
Most Autism Therapy Programs Yes – Good results No No No No

ABA = Applied Behavior Analysis.  VBA = Verbal Behavior Analysis

Mike Frandsen

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Verbal Behavior/Oral Motor Exercises for Children with Autism

May 22, 2009

An important part of any verbal behavior program for children with autism is a commitment to practicing oral-motor exercises. There are many neurological processes that restrict the ability to speak for some children with autism, however, exercising and strengthening muscles around the tongue, lips, and mouth can improve verbal skills to some extent. Here are some exercises that can be helpful. You can use a mirror and do the exercises with your child or student. This can also improve imitation skills, another important area that many children with autism need work on.

Tongue Exercises

  • Lift tongue up to upper lip, then lower lip
  • Lift tongue up behind front teeth to say “la”
  • Open mouth and lick lips with your tongue in a wide circle
  • Click tongue on roof of mouth
  • Whole Tongue Cluck – like a horse’s gallop
  • Stick out tongue as far as you can
  • Stick out tongue and blow out air
  • Push the inside of your cheek out with tongue on the right side, then the left side
  • Mouth circles – put tongue around all teeth
  • De, le, ne, te sounds

Lip Exercises 

  • Pucker lips, make “Cork popping” sound
  • Put finger between lips – make babble sound
  • Lick lips
  • Make an exaggerated sad face 

Other Exercises 

  • Big smile
  • Nose scrunch
  • Open and close your mouth, as wide as you can
  • Show your teeth
  • Puff out cheeks and hold air in, then slowly blow the air out
  • Say “””OOOOOOOOO””” then “””EEEEEEEEEE”””
  • K-k-k-k-k-k-k

Fun activities 

  • Blowing bubbles
  • Blowing pinwheel
  • Blowing dandelions
  • Playing harmonica

Sample words to practice 

  • Yes
  • No
  • Mom
  • Dad
  • Help
  • Play
  • Ball
  • Hungry
  • Juice
  • Bathroom
  • Hi
  • Bye
  • Please
  • Happy
  • Sad
  • Upset
  • Sick

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