august 2016 vol. 11 issue 2 - action for autismautism-india.org/sites/default/files/august...

0

5

25

75

95

100

AUT NET COVER April 2016-f

14 July, 2016 4:39:04 PM

0

5

25

75

95

100

AUT NET COVER April 2016-f

14 July, 2016 4:39:04 PM

AUGUST 2016 VOL. 11 ISSUE 2

AUTISM NETWORK: VOL 11 ISSUE 2~ AUGUST 2016

AUGUST 2016 VOL 11 ISSUE 2

C O N T E N T S

AAAAAction For Autism is a registered, non-profit, national parentorganisation. Autism Network is published by Action For Autismto provide information on education, therapy, care, and to provideinteraction for families and professionals across the country.

Autism Network is a forum for expressing diverse opinions.Action For Autism does not hold itself responsible for opinionsexpressed by individual writers. Publication of any informationdoes not mean support of Action For Autism.

Autism Network does not accept advertisements. Expenses aremet through memberships, donations and sponsorships, from ourreaders, friends and well wishers. This journal is for freedistribution.

INFORMATIONFor information on receiving the Autism Network write to:Pocket 7&8, Jasola Vihar, Behind Sai Niketan, Opp. Gate 6Sector 8, SFS Flats, New Delhi - 110025. Tel: 40540991/2

YOUR CONTRIBUTIONSDo you have any comments, suggestions to offer? Informationand experience to share? We look forward to our readers'participation. Send letters, articles, illustrations to:The Editor, Autism Network at the above given address orE-mail: [email protected]

Editor: Merry BaruaAssociate Editor: Indrani BasuEditorial Board: Dr Nidhi Singhal, Preeti Siwach, SudhanshuGrover, Dr Vibha Krishnamurthy, Shubhangi VaidyaDesign & Production: Bindu Badshah, Sudhir Pillai

In referring to the child with autismIn referring to the child with autismIn referring to the child with autismIn referring to the child with autismIn referring to the child with autism, Autism Networkoften uses ‘he’, ‘him’ and ‘his’, not as a prejudice against thegirl child with autism, but for reasons of simplicity andbecause the vast majority of children with autism are male.However, many articles also use ‘she’, ‘her’, and ‘hers’.

Website:Website:Website:Website:Website: http://www.autism-india.orgHelpline Email:Helpline Email:Helpline Email:Helpline Email:Helpline Email: [email protected]

Page OneThe Dark Side of the Stim: Self-injuryand Destructive HabitsB ED in Special Education ASDCheers for PEERSGame Review: Pyjama PartyDon't Mourn For Us (Hindi)HelplineUpcoming Workshops:'Know Me Teach Me'Tony Atwood: 'Asperger's Syndrome& High Functioning Autism Training'

1

2

6

7

9

11

15

17

17

If you want to help, write to AFA or call:If you want to help, write to AFA or call:If you want to help, write to AFA or call:If you want to help, write to AFA or call:If you want to help, write to AFA or call:

• AFA: 40540991/2 • Reeta: 9811103702

WISHLIST !• Apartment/House for Residence

for people with Autism

• Computers that can support graphicsComputer games, X Box Kinect

• Gym and Sport Equipment, MotorisedTreadmill, Cross Trainer, Punching bag,

Football net, Badminton Net, Basketball ring,Trampoline, Outdoor swings, Indoor plastic

Slide, See Saw

• Playdoh, pull along toys, light and soundmaking toys, Lego, Pretend play toys like:Dolls, doll house, doctor’s sets, furniture

sets, grooming sets, kitchen sets, tea setsetc., Board games like Pictureka, Scrabble,Monopoly, Battleship, Tabboo, Candyland,

Mastermind, Backgammon, Ludo etc.

• Classroom Stationery,• Back issues of Glossy Magazines

• Acrylic Paints• Volunteers: For Yoga, Art & Craft

Cover Illustration

'Field of Flowers'by Pranshu Singh, 19 years.

Violet Class, Open Door School


PAGE ONE

1

As Delhi waits for the monsoon to truly kick in, theambitious Skill India Program appears to aggressivelypromote skilling for employment. The programostensibly provides for employment training of personswith disabilities too; but of course persons with autismand developmental disabilities find no place there.Which is not surprising at all. Individuals with autismdo not find employment, period. A few exceptions do,not because of but rather despite all efforts.

The elusive Rights of Persons with Disabilities Billseems to have drowned in the depths of that potentmix of politics and bureaucracy. Periodically there areexcited murmurs from ‘Those Who Know’ that “the billwill be tabled in the winter session of Parliament,” or“the bill will be tabled in the monsoon session ofParliament”. Woollens have been mothballed, shortsaired, saris and umbrellas hoisted, and in a couple ofmonths Diwali spring cleaning and white washing willstart. Seasons come and seasons go, but the billremains snugly ensconced in the cold storage for thepowerless, those groups that have no ‘clout,’ ‘votes’, or‘voice’.

To add to this static state of affairs there is a moveto declare that special needs schools should ensurethat students with developmental disabilities andspecific needs finish their schooling in seven years andleave school. Schools should make them complete theirlearning, get them independent and fully equipped toface the world within these magic seven years. Henceany Government funding for education will be limited tothose magic seven years. Those who had the privilegeof participating in this discussion soughtenlightenment, in vain, on this astounding new plan;after all, typical children need 12 years to completetheir schooling!

But then, don’t we get the decision makers wedeserve? When parents say: “Any money I spend on mychild with disability will give me no returns, unlike themoney I spend on my ‘normal’ child’, can we expectothers to think any better, or care for the good, of ourchildren?

On a happier note, as those who have been checkingtheir website will know, the National Trust has come up

with some good schemes with sensible allocations.Something to truly cheer about.

So on to other cheerful things.

As Tony Attwood’s much anticipated workshop drawsnear – just three months to go – we wait excitedly fortwo invigorating days of learning. For those of us whohave been fortunate to have attended his workshopsbefore, we cannot wait to share that experience withothers. If autism in all its glorious spectrum is a poorlyunderstood condition, Aspergers Syndrome inparticular, is even less so. Yet a true understanding ofAspergers Syndrome is critical to successfuleducation, employment and life for all those oftenexceptionally verbal individuals, whose physicaldemeanour suggests they blend into the crowd buttheir social behaviour makes them stand out!

Stims are something that we all indulge in, whether wehave autism or we don’t. For the most part they servean important purpose as elucidated by KirstenLindsmith in the last issue of Autism Network. But notall stims are born equal. Not all stims are a healthyaspect of the autistic identity. Stims can sometimesbe extremely harmful. In this issue Lindsmith writesabout the dark side of stims and what we can do tohelp when they take over an individual’s life.

We are very pleased to carry in Hindi Jim Sinclair’sseminal piece ‘Don’t Mourn for Us’. Autism Network hadcarried the original version more than 15 years ago.Reading ‘Don’t Mourn for Us’ in those times had been alife changing experience for this writer. It needs to beread in as many languages as possible.

As the weather gets less hot but more humid we wishour readers happy reading in the rains.

"Many people require various forms ofsensory input to regulate their systems...

people with ADHD benefit from mildbackground music while workingto keep up their dopamine levels

...Stimming can also be an outlet for overload— sensory or emotional — and provide

a feeling of relief and reset fromoverwhelming feelings"


AUGUST 2016 VOL 11 ISSUE 2

C O N T E N T S

AAAAAction For Autism is a registered, non-profit, national parentorganisation. Autism Network is published by Action For Autismto provide information on education, therapy, care, and to provideinteraction for families and professionals across the country.

Autism Network is a forum for expressing diverse opinions.Action For Autism does not hold itself responsible for opinionsexpressed by individual writers. Publication of any informationdoes not mean support of Action For Autism.

Autism Network does not accept advertisements. Expenses aremet through memberships, donations and sponsorships, from ourreaders, friends and well wishers. This journal is for freedistribution.

INFORMATIONFor information on receiving the Autism Network write to:Pocket 7&8, Jasola Vihar, Behind Sai Niketan, Opp. Gate 6Sector 8, SFS Flats, New Delhi - 110025. Tel: 40540991/2

YOUR CONTRIBUTIONSDo you have any comments, suggestions to offer? Informationand experience to share? We look forward to our readers'participation. Send letters, articles, illustrations to:The Editor, Autism Network at the above given address orE-mail: [email protected]

Editor: Merry BaruaAssociate Editor: Indrani BasuEditorial Board: Dr Nidhi Singhal, Preeti Siwach, SudhanshuGrover, Dr Vibha Krishnamurthy, Shubhangi VaidyaDesign & Production: Bindu Badshah, Sudhir Pillai

In referring to the child with autismIn referring to the child with autismIn referring to the child with autismIn referring to the child with autismIn referring to the child with autism, Autism Networkoften uses ‘he’, ‘him’ and ‘his’, not as a prejudice against thegirl child with autism, but for reasons of simplicity andbecause the vast majority of children with autism are male.However, many articles also use ‘she’, ‘her’, and ‘hers’.

Website:Website:Website:Website:Website: http://www.autism-india.orgHelpline Email:Helpline Email:Helpline Email:Helpline Email:Helpline Email: [email protected]

Page OneThe Dark Side of the Stim: Self-injuryand Destructive HabitsB ED in Special Education ASDCheers for PEERSGame Review: Pyjama PartyDon't Mourn For Us (Hindi)HelplineUpcoming Workshops:'Know Me Teach Me'Tony Atwood: 'Asperger's Syndrome& High Functioning Autism Training'

1

2

6

7

9

11

15

17

17

If you want to help, write to AFA or call:If you want to help, write to AFA or call:If you want to help, write to AFA or call:If you want to help, write to AFA or call:If you want to help, write to AFA or call:

• AFA: 40540991/2 • Reeta: 9811103702

WISHLIST !• Apartment/House for Residence

for people with Autism

• Computers that can support graphicsComputer games, X Box Kinect

• Gym and Sport Equipment, MotorisedTreadmill, Cross Trainer, Punching bag,

Football net, Badminton Net, Basketball ring,Trampoline, Outdoor swings, Indoor plastic

Slide, See Saw

• Playdoh, pull along toys, light and soundmaking toys, Lego, Pretend play toys like:Dolls, doll house, doctor’s sets, furniture

sets, grooming sets, kitchen sets, tea setsetc., Board games like Pictureka, Scrabble,Monopoly, Battleship, Tabboo, Candyland,

Mastermind, Backgammon, Ludo etc.

• Classroom Stationery,• Back issues of Glossy Magazines

• Acrylic Paints• Volunteers: For Yoga, Art & Craft

Cover Illustration

'Field of Flowers'by Pranshu Singh, 19 years.

Violet Class, Open Door School


2

The Dark Side of the Stim:Self-injury and Destructive Habbits

Kirsten Lindsmith*

In my previous article, ‘Stimming 101’**, I wrote aboutautistic stimming as a normal and healthy aspect ofautistic identity. While this is most often the case, Iwant to follow up with a slightly different article,because not all stims are created equal.

Sometimes stimming is unhealthy or even dangerous.Parents, caregivers, and autistic people all need tools todeal with these types of stims. We in the autisticadvocacy community often paint all stimming aswonderful and healthy, leaving high and dry those whoneed help. So, let’s talk about the dark side of the stim.

The Dark SideOne of the most frequent questions I get from readersis what to do about unhealthy stimming. These requestscome from both non-autistic caregivers and autisticpeople.

A few typical examples include children who bang theirheads against walls, teenagers who bite their fingersand nails until they bleed, or adults addicted to self-harming behaviors like cutting or burning.

As I discussed in Stimming 101, stimming serves avariety of purposes.Many people require various forms of sensory input toregulate their systems. For example, people withADHD benefit from mild background music whileworking to keep up their dopamine levels and maintainfocus.

Stimming can also be an outlet for overload—sensoryor emotional—and provide a feeling of relief and resetfrom overwhelming feelings. Examples of this can evenbe seen in overexcited neurotypicals.

Related to the latter, but slightly more extreme:stimming can provide a safe haven from full overloadand meltdown. Regular, strong stimulation provides afocus point for the body and mind, helping to shut outpainful stimuli.

• LEAD ARTICLE •

The stronger the overload, the stronger the stim has tobe to provide the needed relief.

This last purpose is a primary source of unhealthystimming, for this very reason.

Everything Louder than Everything ElseHow do we respond to discomfort? To fear?Let’s look first to film and literary clichés forexamples…

We grit our teeth and bear it. We ball our fists and digour nails into our palms. We bite our tongues to keepfrom screaming. We pinch ourselves. We slaphysterical people to knock them out of it.

What do all these methods have in common? They allinvolve the distraction of pain as a coping mechanism.

Have you ever been so upset that you instinctivelyretreated to the distraction of overwhelming stimulation,even in a mild way? Perhaps you relished the burn of apure shot of vodka, squeezed your hands together a bittoo tightly, or jumped into a too hot shower.

There’s a reason pain is the universal distractor. Pain isthe only form of stimulation that our nervous systemswill not acclimate to.

All other sensory receptors, when continuallystimulated, eventually stop firing.

If you walk into a house with too many cats, you maycringe at the strong scent of kitty litter, but if you stayand hang around you’ll stop noticing the smell. Thisisn’t about attention, this is a physiological reaction.You really do stop smelling the cat pee.

But if you’re in pain, you won’t acclimate to it. As longas the reason for the pain is still present, your nervoussystem will keep on sending you those signals. Not onlythat, but it will prioritize that sensation above others.


3

Pain is perhaps the strongest bodily sensation we have. Itcovers and blocks out all other sensations. This is whatmakes it so useful—it tells us when something is wrong.It keeps us safe when we are injured and need to tend toour wounds. But this is also what makes it so dangerousfor those prone to sensory overload.

Most people have never felt sensory or emotionaldiscomfort so strong they would injure themselves tocover it. But to a person with a sensory or emotionalprocessing difference that threshold can be much easierto reach.

Types of Unhealthy StimmingI’m going to focus here on the most common types ofunhealthy stimming that readers bring to me. There arealways going to be exceptions that don’t fall into a neatlabel, but in an effort to be as practical as possible, I’lldivide unhealthy stims into two major categories:Overload, and bad habits.

1. OverloadThese are the stims that drown out everything else.Including:

• Hitting the head (against a hard surface or withobjects)

• Biting or scratching the hands, arms, or other parts ofthe self

• Hitting oneself or throwing the self against hardsurfaces

• Other extreme injurious behaviors that come onsuddenly and forcefully

2. Bad HabitsThese stims, while still unhealthy, are done in a moreslow and controlled way. They may come on graduallyand escalate, or may occur at low levels continually.Including:

• Biting, picking, or scraping at the finger or toe nails tothe point of injury

• Dermatillomania and trichotillomania (skin picking andhair plucking, respectively)

• Self-harm behaviors such as cutting, burning, stabbing,etc.

• Biting or scratching the self at a continuous, low-gradelevel (e.g., chewing on the hands)

• Pica (eating non-food items, such as paper or tinfoil)

• Other dangerous or injurious behaviors that are donerelatively calmly, either continuously, in all or mostcontexts, or under stress

Addressing Overload BehaviorsThere are two primary ways to interrupt dangerousoverload stimming. The first is to remove the problemstimulus that’s causing the overload. The second is toredirect the behavior while still addressing the need forstimulation. Usually, some combination of the twomethods will be most effective.

Removing the ProblemThis first method is most effective as preemptiveintervention, or during the initial, ramp-up stages ofmeltdown.

Preemptive intervention requires the problem stimulusto be specific, predictable, and controllable.

For example, my mother once worked with an autisticlittle girl who had several triggers along these lines. Ifshe heard a studio audience applauding on TV, or sawher sister’s bellybutton, it would set off an intense self-injurious meltdown. These meltdowns could be avertedpreemptively, by turning off the kids’ favorite showbefore it panned to the audience, and by bathing anddressing the girls separately.

Removing a problem stimulus can also be effective ifyou catch the meltdown during the early stages. I onceworked with a little boy who would start pulling at hishair in the build up to a meltdown. If the build upcontinued, he would progress to hitting himself in thehead with his fists. Hair pulling was the warning sign Iwatched for.

If you are the caregiverIntervene with this method if you know a trigger iscoming, see the problem behavior beginning, or noticewarning signs that it is about to start.

If you are the autisticIf you struggle with dangerous overload behaviors,tracking your own meltdowns is similarly important. Ifpossible, it’s helpful to have a second person who cankeep track of your meltdown patterns for you. If youdon’t have that luxury, then journaling during mild tomoderate overload is one alternative (journaling duringfull meltdown is usually impossible).

One way to begin the process of tracking your warningsigns is to use an app that will remind you at intervals torecord how you feel. I recommend either defaultreminder apps (setting reminders at hourly intervals), orsomething like iMoodJournal for iOS.


2

The Dark Side of the Stim:Self-injury and Destructive Habbits

Kirsten Lindsmith*

In my previous article, ‘Stimming 101’**, I wrote aboutautistic stimming as a normal and healthy aspect ofautistic identity. While this is most often the case, Iwant to follow up with a slightly different article,because not all stims are created equal.

Sometimes stimming is unhealthy or even dangerous.Parents, caregivers, and autistic people all need tools todeal with these types of stims. We in the autisticadvocacy community often paint all stimming aswonderful and healthy, leaving high and dry those whoneed help. So, let’s talk about the dark side of the stim.

The Dark SideOne of the most frequent questions I get from readersis what to do about unhealthy stimming. These requestscome from both non-autistic caregivers and autisticpeople.

A few typical examples include children who bang theirheads against walls, teenagers who bite their fingersand nails until they bleed, or adults addicted to self-harming behaviors like cutting or burning.

As I discussed in Stimming 101, stimming serves avariety of purposes.Many people require various forms of sensory input toregulate their systems. For example, people withADHD benefit from mild background music whileworking to keep up their dopamine levels and maintainfocus.

Stimming can also be an outlet for overload—sensoryor emotional—and provide a feeling of relief and resetfrom overwhelming feelings. Examples of this can evenbe seen in overexcited neurotypicals.

Related to the latter, but slightly more extreme:stimming can provide a safe haven from full overloadand meltdown. Regular, strong stimulation provides afocus point for the body and mind, helping to shut outpainful stimuli.

• LEAD ARTICLE •

The stronger the overload, the stronger the stim has tobe to provide the needed relief.

This last purpose is a primary source of unhealthystimming, for this very reason.

Everything Louder than Everything ElseHow do we respond to discomfort? To fear?Let’s look first to film and literary clichés forexamples…

We grit our teeth and bear it. We ball our fists and digour nails into our palms. We bite our tongues to keepfrom screaming. We pinch ourselves. We slaphysterical people to knock them out of it.

What do all these methods have in common? They allinvolve the distraction of pain as a coping mechanism.

Have you ever been so upset that you instinctivelyretreated to the distraction of overwhelming stimulation,even in a mild way? Perhaps you relished the burn of apure shot of vodka, squeezed your hands together a bittoo tightly, or jumped into a too hot shower.

There’s a reason pain is the universal distractor. Pain isthe only form of stimulation that our nervous systemswill not acclimate to.

All other sensory receptors, when continuallystimulated, eventually stop firing.

If you walk into a house with too many cats, you maycringe at the strong scent of kitty litter, but if you stayand hang around you’ll stop noticing the smell. Thisisn’t about attention, this is a physiological reaction.You really do stop smelling the cat pee.

But if you’re in pain, you won’t acclimate to it. As longas the reason for the pain is still present, your nervoussystem will keep on sending you those signals. Not onlythat, but it will prioritize that sensation above others.


4

Focus on physical sensations:How does your stomach feel? How do the muscles inyour face feel? Do you feel hot or cold? And if so,where? Do you feel numb or tingly anywhere? Keeptrack of what your body is doing at continuous intervals.Then, if you have a meltdown, you can later look backover your journal entries and check out how you werefeeling in the hours leading up to it. Similarly, justsetting continual reminders to check in with yourselfcan help you avoid meltdowns entirely. I’ll write afuture post on how to develop these types of meltdowncoping skills.

The important element is learning to identify the signsthat a meltdown is coming, and to interrupt it before itreaches the point of no return. Whether that meansleaving a party, turning off the music, or moving to aquiet, dark room, this method is about removing aproblem.

This method is NOT helpful if the problem is anemotional one. For anyone who struggles withemotional overload, I recommend seeking DialecticalBehavior Therapy (DBT) or Cognitive BehavioralTherapy (CBT) from a qualified provider withexperience working with your particular diagnosis. Ifyou don’t know where to start, I recommend browsingthe Psychology Today directories.

Redirecting the behaviorThis method is the most practical, and the one you willprobably need to make use of the most often.What if the problem stimulus is schoolwork? Wearingclothes? A perceived slight from a stranger? Anargument with a significant other? Puberty?What if the stimulus can’t be identified, can’t beremoved practically, or is too abstract to remove? Orwhat if the meltdown is already so intense thatremoving the stimulus doesn’t help?In situations like these, the dangerous stimming needsto be redirected, and replaced with a safe stim thatserves the same purpose.

If you are the caregiverIt is your job to find a way to provide intense,unignorable stimulation that will drown out the worldand provide a focal point for the person having themeltdown. The type of input depends on the person.

For example, that little boy prone to hair-pulling andhead-hitting I mentioned earlier favored auditory andvestibular input. Playing a favorite song very loud,

while picking him up and swinging him around, was thebest way to help him through his meltdowns.

A few examples of safe, intense stimulation to provideare:• deep pressure (squeezing up and down the arms,pinching the finger tips, a strong bear hug, or lying on topof the person)• vibration in the chest area or around the mouth (amassager on the chin and mouth area, or rhythmiclypounding on their back with your hand)• loud music (playing a rhythmic, sensory oriented song,or singing right in their ear)• strong vestibular input (spinning or pushing them in aswing, or, if size and strength allow, picking them upand spinning them around)

If you’re not sure what kind of stimulation your chargelikes best, pay attention to what they’re seeking throughtheir behavior.• Is she hitting or biting herself? She needs deeppressure. Focus first on the areas she’s hitting.• Is he screaming? He needs auditory input. Play someloud music. Using your phone is best, since you canmove it around. For added input, move the speaker backand forth, from one ear to the next, or move it forwardand back, close to the ear and away again.• Is she throwing objects, trashing the room, or throwingherself on the floor? She needs vestibular input. Put herin a swing, on a bouncer or trampoline, or pick her upand spin her around.

If you are the autisticStart by compiling a list while you’re calm of ideas forintense sensory input. Keep multiple copies scatteredaround, such as on your phone, on your computer, andposted up on your fridge. You need a bank of sensoryoptions that you can keep adding to over time. Ideally,what you’re looking for are different types of intensestimulation that can provide a sensory buffer or sensoryreset to give you the input you need without resorting tohurting yourself.

A few of my favorites are:• Hold ice cubes• Have another person sit on you, or invest in a weightedblanket• Keep a playlist of intense, sensory oriented music youcan blare in headphones (feel free to contact me forrecommendations)• Squeeze your wrists, hands, and finger tips (push downon the nail) instead of biting or scratching


5

• Take a cold shower or bathAgain, the goal is to keep adding to the list every timeyou think of or find a new idea.Addressing Bad HabitsBad habits are often more difficult to deal with thandangerous meltdowns. Where meltdowns come and golike hurricanes, bad habits are ever-present. But similarguidelines apply for handling these. You can try toremove the trigger, redirect the behavior, or both.

Removing the triggerThis one isn’t always possible with bad habits, sadly.But for some habits, it can be.For example, If your child eats glue, and you’ve triedand failed to redirect this, your next step is to lock upthe glue.

One of the bad habits I have is biting my lips. Forwhatever reason, my lips chap very easily. This meansI nearly always have little tears and flakes of skin onmy lips. If and when I inevitably feel them (either witha finger or by rubbing my lips together), I compulsivelybite at the flaps of skin and peel my lips to pieces. Themore I bite, the more flaps and flakes appear. It’s aself-propagating cycle. The only way I’ve found tointerrupt this behavior in myself is to always have lipbalm available. If I can smooth down the flaps andflakes with balm, I won’t feel them as much, and then Ican avoid the trigger (feeling the rough texture) thatcauses the behavior.

I was able to quit biting my nails much the same way.But because this process was more involved than simplyapplying lip balm preemptively, I’ll include it underredirection.

A Note About Root CausesI recently received a message that reminded me ofsomething I had earlier forgotten to address here. Many“bad habits” or self-destructive stims can come fromroot causes that need to be addressed. For example, themessage I got was a story about a root cause I’ve heardhappen to more than one person: An autistic teensuddenly developed a new, very violent stim of banginghis head against the wall. He was brought to doctorafter doctor, and no one could figure out the problem.

One professional even went so far as to dismiss theissue, telling the boy’s parents that this was “justsomething autistic people do,” and they would have toget used to it. Eventually, they noticed something. Hiswisdom teeth were coming in impacted, pressing into a

nerve! He was in horrible pain, and banging his headagainst the wall was his only coping mechanism.

Often if there’s some underlying medical issue it maygo unchecked because an autistic person can’t speak toeffectively explain the problem. These issues may alsogo overlooked in more verbal autistics, if due toalexithymia, they either don’t understand the problemthemselves, or can’t articulate it well.

Some examples of common medical issues that cancause self-injurious behavior are:• Inflammation (allergies, autoimmune disorders, foodintolerances, bad drug reactions)• Dental issues (cavities, new teeth budding, brokenteeth, mouth injuries)• Gut issues (IBS, celiac, injuries, menstrual cramps orPMS, UTIs)• Headaches (migraines, low blood sugar, low bloodpressure, TMJ/jaw cramps)

Redirecting the behaviorRedirection involves identifying the sensory need that’screating the stim, and filling it another way.Besides lip balm, another thing that keeps me frombiting my lips is having chew toys on hand. My favoritestim toy supplier, Stimtastic, sells adult-friendly“chewelry” that looks nice to wear while still serving itspurpose. Chew toys can also help with pica, though Iwould advise getting only the strongest toys, or else thetoy itself can become the dangerous object.

I once worked with a teenage boy who chewed at hisfingers and scraped them with his teeth nearlyconstantly. This would create ever-present woundssmall and large on his hands. The only way I found toredirect this behavior was to give him something to holdwith a rough texture. The more texture, the better. Hecould then rub the thing he was holding instead ofrubbing his fingers against his teeth.

While I never had issues with chewing or scraping myfingers, I did bite my nails compulsively andunconsciously for over 10 years. I would bite them downso far that my fingers were constantly in pain. Theprocess for overcoming this habit was long, and verymethodical. I’ll share the details, because I’ve foundthat the steps I used to break this habit have beenessential in breaking others.

How I stopped nail bitingBecause I was biting unconsciously, I couldn’t simply


7

Karl is a 17 year old young man with autism who goesto mainstream college. He is a good student and doeswell in his exams. His biggest challenge is that hiscollege-mates bully him into doing their homework forhim and he feels that he should help his ‘friends’ nomatter what! Ravi is a 13 year old boy with autism whoalso goes to mainstream school. Shyam has a couple offriends in school and he loves to talk to them about hisaction figures. He often reports that his friends walkaway in the middle of his conversation with them andhe struggles to figure out why! Aliya, a 15 year old girlwith autism complains to her mum that her friendsmake funny faces when she tries to join theirconversations.

Autism or ASD is a spectrum condition that affectsdifferent people differently. It is sometimes easy todetect, especially when the symptoms are quite obvious.However, there are many individuals with ‘higherfunctioning autism’ or as I prefer to refer to them –individuals that are less impacted by the condition, whocan function within the typical range with regard tolanguage and intelligence and sometimes their autismeven goes undetected. Most often they have greatdifficulties in social skills – in making friends andkeeping them so. During adolescence, the demands ofpeer relationships increase and the individuals who areless impacted by autism tend to be self conscious oftheir difficulties in socialization. This can lead todepression and anxiety, isolation, teasing, bullying,rejection, low self-esteem, school drop-out andunemployment.

While the momentum of early intervention services inautism in India is gaining, there is lack of social skillstraining programs to work with less impactedindividuals with ASD. The result is that their poorability to socialize preludes them from havingmeaningful social relationships. It is not the lack ofdesire to make friends – they desperately want to do sobut fail miserably when trying. This failure is due to thelack of effective programs and inadequate resources toteach social skills. For most neurotypical children, basicsocial skills like turn taking and initiating a conversationcan be acquired easily but for those with autism, theprocess can be tough. While many neurotypicals learnthese skills simply by being exposed to different social

situations, the neurodiverse children need specificteaching to help improve their socialization skills.

In February 2015, Action for Autism organized aworkshop on social skills training called PEERS(Program for the Education and Enrichment ofRelational Skills) that was conducted by Dr. ElizabethLaugeson, clinical psychologist and an Assistant ClinicalProfessor in the Department of Psychiatry andBiobehavioral Sciences at UCLA and co-author of thePEERS Program. PEERS incorporates and builds onmany elements that are integral to successfully teachingsocial skills. This program is evidence based on a largesample in the US and the great thing about it, is that it ismanualised - which means it can be adapted andreplicated. The intervention has had positive effects onthe social skills of many adolescents with autism in theUS and this could be a life changing program forthousands of adolescents with autism in India too.

The PEERS Program is a 14-week training that coverstopics right from how to exchange information whenhaving a conversation and what to do when you invitea friend over to your house, to how to use appropriatehumour and how to handle bullying in school. It requiresparticipation of the child as well as one of his/herparents so that whatever skills are taught can bepracticed and generalized to real world situations.

I attended the PEERS training program in February 2015with the aim of introducing social skills training foradolescents in with autism in Goa. Goa does not have anysort of socialization program for people with autism atall, and this was a great opportunity to change the lives ofso many individuals with ASD and their families. Sethu,being Goa’s premier organization for child developmentservices has a large number of clients with autism thatcould benefit from social skills training. It could changethe lives of so many children in Goa and Sethu’s servicesin autism intervention could be strengthened. However,I was apprehensive that convincing parents that theirchildren could use this training and hoping they would beable to take time out of their busy schedules to participatein it would be a difficult task.

As soon as I returned from Delhi, I conducted a smalltraining for the professionals at Sethu who were

Cheers for PEERSAndre Velho*


6

This article was first published on https://kirstenlindsmith.wordpress.com/2016/02/05/the-dark-side-of-the-stim-self-injury-and-destructive-habits/andhas been reprinted with the permission of the author.

*Kirsten Lindsmith is an author, artist, consultant, andautism advocate. After receiving an ASD diagnosis atthe age of 19, she began co-hosting the online televisionshow Autism Talk TV, and speaking about herexperience as a young woman on the spectrum. Kirstenhas written columns for WrongPlanet.net andAutismAfter16.com, and was profiled in The New YorkTimes in a feature titled Navigating Love and Autism.She is a member of the board of advisors for the YaleChild Study Center’s Initiative for Girls and Womenwith Autism Spectrum Disorder. Kirsten currentlyworks as a special needs nanny in partnership withMelody of Autism, and as a consultant for parents,professionals, and individuals on the spectrum.She maintains a blog at:KirstenLindsmith.Wordpress.com where she writesarticles about ASD.

**Lead Article Autism Network April 2016

decide to stop. I first had to identify the warning signs.For this, I enlisted the help of a second person.

I told my boyfriend at the time to watch me, withoutinterrupting the biting, and tell me what the processlooked like.

He told me that before I started biting, I would begintouching my fingernails. I would feel along my nailswith the tips of my fingers, and rub my nails against mylips. I was feeling for rough patches. Then, when Iinevitably found some irregularity, I would bite. Thiswas the point of no return, because if I found a roughpatch, I had to get rid of it. I couldn’t choose not to. Itbecame a compulsion.

At first I tried to stop feeling for rough patches. But thisignore simply wasn’t practical. I couldn’t avoid touchingmy fingers in my everyday life, let alone break the habitof feeling for rough spots.

So I found a way to redirect, to choose a healthyalternative.I started carrying a nail kit with me.I kept a nail kit in my bag. And if I didn’t have a bag,I made sure to have a nail file in my pocket.

From that point on, whenever I felt a rough spot on anail, I could file it down. I could get rid of the roughpatch without biting. And filing away a rough patchalways removed less nail and skin than if I had triedbiting it away, because biting only created more roughspots.

Eventually, as time went on, my nails grew long enoughthat I could fully redirect the habit into something nolonger destructive. Now, I have a new stim to do withmy fingers. Something I do constantly, unless I’mholding something. Now, I clean under my fingernails,whether there’s something under them or not. It lookseither snobby or slobby, depending on context. But atleast I’m not biting!To summarize, the best methods for redirecting badhabits involve finding a similar stimulus. If the habitinvolves the mouth, use gum, or a chew toy. If itinvolves the hands, find a fidget toy.

Some bad habits are more difficult to redirect, such asself-harm.

A few quick examples of ways to redirect self-harmbehaviors and distract yourself from these thoughts are:

• scribbling on a piece of paper until the entire page isblack• drawing pictures on your skin• following other painful-but-safe coping strategies, likethose listed above in the overload section (holding icecubes, cold shower, loud music, and so on).If you’re struggling to break a habit or addiction to self-harm, feel free to contact me via email and I can helpyou design a more personalized coping plan.Stimming is amazing, healthy, and necessary, yes, butsometimes it can be horrible and dangerous. I hope thispost helps anyone struggling with unhealthy stimming.And to all my readers, please contact me if you havequestions about anything I talked about here, or aboutanything I’ve left out. I’m here to help, if I can!

~ ADMISSIONS OPEN ~

B ED in Special Education Autism SpectrumDisorders 2016-18 @ Action for Autism

Certified by Rehabilitation Council of IndiaIn affiliation with

Guru Gobind Singh Indraprastha University

Contact: +91 11 2530 2167, 68 - 69


8

convinced that this program could be a success. Since itrequires 2 trainers - one for the adolescents and one forthe parents, Sethu’s director, Dr. Nandita de Souzavoluntarily and enthusiastically partnered with me toimplement PEERS in Goa. Dr. de Souza had alreadypreviously created a list of children she had seen over10 years who she thought would benefit from some sortof social skills instruction, and this was a greatopportunity for these now adolescents to get the trainingthey needed.

We adapted and tweaked the program as minimally aspossible to make it appropriate to the Goan situation.Because of the pressures of school and examinations,we decided to reduce the duration of the program from14 to 10 weeks so increase the likelihood ofparticipation. Some modules were combined andconducted together instead of separately. We had toleave out one module due to time constraints and wechose to exclude what we taught was the leastapplicable out of all the modules.

Using the best of our convincing skills and we contacted10 families to participate in PEERS. A few of theadolescents were in the 10th standard and could notattend it this year. Many parents lived far from Sethuand worked full time outside the home and could notcommit to 10 continuous weeks. Finally, four of themagreed to participate. One mother desperately wantedher daughter to participate but her daughter refused takepart. Since PEERS is totally voluntary and both – parentand child should want to participate, we could not forcethe matter. Four was finally our magic number.

In September 2015 we kick started the program – Iworked with the adolescents and Dr. de Souza workedwith the parents at the same time but in separatesessions. It was imperative for the parents towholeheartedly participate in the program since theywould act as their children’s social coaches at home andin real social situations. Over 10 weeks, the familiescame to Sethu with the hope and enthusiasm that thisprogram was going to significantly change the way theadolescents interacted with their friends. They werebetween the ages of 13 and 18 and took time out of thehomework, extra-curricular activities and free time tocome to Sethu once a week. They all knew theimportance of what they were learning and week byweek their improvements were clearly visible.

Each session began with a homework review of theassignment from the previous week (each week the

family was given a social skills assignment whichbasically was practicing what they had learned at home/atschool/at different social situations). This usually tookabout 15 minutes and any troubleshooting of problems wasdiscussed. The main lesson for the day was presenteddidactically and was enhanced by video-demonstrationssince people with autism are extremely good visuallearners. Role-plays were also used in the session so thatthey could practice what they learned at that time itself.Dr. de Souza and the parent-group would go over the samelesson as their children but in a separate session. Parentswere instructed on ways in which they could help theirchildren overcome difficulties through weeklysocialization homework assignments. The sessionsconcluded with parents and adolescents reunited in thesame room where the assignment for the day wasdiscussed.The role of the parents was to coach their children andmonitor them when practicing different social skills and indoing their homework – they were asked not to do thehomework for them! This team approach that PEERSencourages was what got the homework done each week.It gave us great joy and satisfaction to hear about hardwork that the families put in each week to complete theirassignments. Every participant had different issues eachweek that that they needed help with and were very opento discuss the same. Whether the challenge was notknowing who was in charge of choosing a game when theyinvited a friend over, or not accepting that humour isappropriate and it is OK to tell jokes, the participants withASD themselves most often provided valid solutions to theothers’ difficulties!

The greatest quality of this program is that it is totallyvoluntary - no parent or child was forced to attend it. Theparents could not force their children to attend either. As aresult, we hardly encountered any behavioural challengesor disciplinary issues. Any minor ones that did come upcould be easily resolved by simply presenting rules ofexpected and unexpected behaviours and going over thesame. Further, there was not a single day of absenteeismamong the parents which was truly remarkable.

It was important for us to understand whether and howmuch the program was helping the families and so weused two outcome measures to test this. One of them wasthe Test of Adolescent Social Skills Knowledge (TASSK)which is a self-administered questionnaire completed bythe adolescents. It assessed their knowledge about specificsocial skills taught during the intervention. The scores ofthe TASSK range from 0-26, with higher scores reflectinggreater knowledge of the taught social skills. The average


*Andre Velho is an autism interventionist at Sethu ChildDevelopment and Family Guidance Centre in Goa.After obtaining a master of arts degree in Autism in theUK, Andre felt the need to come back to Goa, use hisknowledge and expertise and give back to the place hecalls home. He loves music and cars and plays in aband part time!

score before starting PEERS was 12 out of a maximumof 26 points. When they were reassessed aftercompleting the 10 weeks, their average score went upfrom 12 to 22 points – a difference of 10 points!

We also wanted to assess the adolescents’ core autisticsymptomatology and so the Social ResponsivenessScale (SRS) was used to measure this. The SRSassesses the severity of autism symptoms as they occurin natural social settings and it is a questionnaire filledin by the parents. Higher the score – more is the impactof autism in the adolescents’ social life. Before starting,the average SRS score was 74 but after attendingPEERS it dropped 9 points to 65!

These outcome measures showed no doubt that PEERSwas effective in improving the knowledge of variouscrucial social skills and helped reduce the symptoms ofaut ism that were hampering these participants fromhaving meaningful and social relationships with theirfriends.

The 10 weeks of PEERS at Sethu was a learningexperience for everyone involved. Sure there werehiccups along the way – whether it was videos notloading, homework not done, family reaching late or toomany snacks to focus on the lesson, it was afantastically fulfilling rocky road journey. We hadlovely feedback from the parents and here is what acouple of the parents had to say –

“PEERS was a great guidance program for my son. Henow wants to organize frequent barbecue get-togetherswith his friends. He has joined a new school and on arecent visit, a couple of his friends asked me to tell himnot to tease them. After enquiring further, I found outthat he was using the ‘tease-the-tease’ approach tobeing teased himself by them! This made me overjoyedand we both did a victory dance! I feel this programshould also be adapted for younger children since theyhave a chance to learn social skills and how to defendthemselves right from a young age.”

“We had a good opportunity to be part of PEERS. It waswith a group of parents and the teens together doingtheir exercises successfully. It was well laid out and wehad lots of guidance in creating a friendly environmentfor our teens. It also provided a chance for us parents todiscuss our teens’ social skills. Overall it was a greatexperience. Our son has since been attending his musicclasses happily with other students. He has alsoattended a local summer camp which he enjoyed.”

Although it would be easy to rest on our laurels, it isurgent that we continue this program and reach out tomany more families across Goa. We are looking to startthe second batch of PEERS this coming September andwe hope that it will be as or more successful thatbefore.

Game Review by Maithri Sivaraman*

Learn Through Play

Pajama Party (INR 299)

From Chalk and Chuckles

There is no question that play is an integral part of childdevelopment and we know that children with autismoften find it very hard to play in a manner that isbeneficial to their development. The best way to fostergrowth in this area is to target it during early intervention.Here is a review of a game that could aid families,therapists and educators initiate their students into theworld of play.

GamePajama Party

Age LevelPreschool and kindergarten

DescriptionPajama Party is a very well-designed game by Chalk andChuckles and has been a huge hit with my young learnerswith autism. It allows me to help them practiceidentifying colours, scanning arrays, visual discriminationand picture descriptions. Marvin, the cow, throws aPajama Party to all his cow friends who come dressed ina mixture of colours. They bring cake, presents, gifts,balloons and more. The game comes with a pair of dice,21 double-sided cards of cows and 21 thinking cards.

Skills and ModificationsThe game has two parts and is designed to suit both

9


11

bl ys[k dk izdk’ku gekjh vkokt] vkWfVLe usVodZbUVjus’kuy dkaÝsUl VksjkUVksa ds O;k[;ku dh:ijs[kk gS vkSj ;g eq[;r% vkWfVfLVd cPpksa dsekrk&firk dks lEcksf/kr gSA

ekrk&firk dgrs gSa fd budk cPpk ^vkWfVfLVd* gS;g ckr muds lkFk gqbZ lcls ihM+knk;d ?kVuk gSAfcuk vkWfVLe vFkok lkekU; yksx vkWfVTe dks ,dcM+h =klnh dh rjg ns[krs gSa vkSj ,sls eka&ckivius vkWfVfLVd cPps vkSj ifjokj ds thou dkyds gj iM+ko ij yxkrkj fujk’kk o ek;wlh eglwldjrs gSaA

bl nq%[k dh mRifRr dk dkj.k flQZ vkWfVfLVdcPps dk thou esa vkuk ugha gSA ;g eka&cki dhmEehn fd;s gq, ,d lkekU; cPps ds u gksus@[kksusdk gSA vkWfVfLVd bUlku ds lkFk okLrfod thoudh tfVyrkvksa ds ctk; ekrk&firk dk utfj;k]vk’kk;sa vkSj ,d [kkl mej esa bl cPps ds fodklesa foHksn eq[;r% mudh ruko vkSj ihM+k dk dkj.kg S A

FkksM+h ek=k esa nq%[kh gksuk lkekU; gS D;ksafdeka&cki dks bl gdhdr dk lkeuk djuk iM+rk gS]fd ftl ?kVuk o lEcU/k dh oks vk’kk dj jgs Fksoks vlfy;r esa ugha gksxh] vkSj blds vuqdwy [kqndks cukuk iM+rk gSA ijUrq vius euksokafNr lkekU;cPps ds u gksus ds nq%[k ds izfr vuqHkwfr mUgsa] viusvkWfVfLVd cPps ls vyx j[kus dh t:jr gSA mlvkWfVfLVd cPps dks ftls O;ld dk;Zokgdksa ds lkFklqvolj feyus ij og ,d lkFkZd lEcU/k cukldrk gSA yxkrkj vius nq%[k dh tM+ dk dsUnz

vkWfVLe dks ekuuk eka&cki o cPps nksuksa ds fy,gkfudkjd gS vkSj ;g nksuksa ds chp esa Lohdkjrk vkSjfo’oluh; lEcU/k ukeqefdu dj nsrk gSA Lo;a dsfy, vius vkWfVfLVd cPps ds fy, ekrk firk dsle{k rhoz bPNk j[krk gwa fd oks vkWfVTe ds izfrvius n`f"Vdks.k esa tM+ ls ifjorZu yk;saA eSa vkidksgekjs vkWfVTe vkSj vkids nq%[k dks gekjs nf"Vdks.k lsns[kus ds fy, vkeaf=r djrk gwaA

vkWfVTe ,d yVdu@tksM+ ugha gSvkWfVTe fdlh O;fDr ds }kjk ,d tksM+h gqbZ oLrq ;kyVdu vFkok ,d dop ds vUnj Qalh gqbZ dksbZ phtugha gS u gh fdlh vkWfVfLVd cPps ds vUnj ,dlkekU;@uku&vkWfVfLVd cPpk Nqik gqvk gSA vkfVTevius esa ,d vyx thou gS ftldk viuk ,dvfLrRo gSA ;g cgqr O;kid gSA ;g thou ds gjvuqHko gj ,glkl] gj vuqHkwfr] gj fopkj] gjHkkouk] thou ds gj igyw ls lkeuk] mlds vfLrRolc ij viuh Nki NksM+rk gSA vkWfVTe dks fdlh dsvfLrRo ls vyx djuk eqefdu ugha gS] vkSj vxj,slk eqefdu gksrk rks vkids iz;Ru ds ckn ;gvkWfVfLVd O;fDr tks vkt vki ds ikl gS ml O;fDrls fcydqy vyx gksrk ftlds lkFk vkius 'kq:vkrdh FkhA

;g cgqr t:jh gS fd vki ,d {k.k dk le; ysdjbl ckr ij fopkj djsaA vkWfVTe dk vius esa ,dvyx vfLrRo gS vkSj vkWfVfLVd O;fDr dks mldsvkWfVTe ls vyx j[kuk eqefdu ugha gSA

blfy, tc eka&cki dgrs gSa %^^dk’k esjs cPps dks vkfVTe ugha gksrk** rks vlfy;r

gekjs fy, 'kksd u djsagekjs fy, 'kksd u djsagekjs fy, 'kksd u djsagekjs fy, 'kksd u djsagekjs fy, 'kksd u djsafte feuDySjfte feuDySjfte feuDySjfte feuDySjfte feuDySj

vuqokn & iwtk [kUuk vuqokn & iwtk [kUuk vuqokn & iwtk [kUuk vuqokn & iwtk [kUuk vuqokn & iwtk [kUuk


10

preschool learners as well as those in kindergarten andelementary school. You can remove the thinking cardsand only use the dice and cow cards for the preschoolkids.

Colour Identification and MatchingThe game is originally designed to identify two coloursat a time. Some kids might find that very hard to do.With my very young players I only use one dice at atime and pick out the cards that have cows wearing thesame coloured shirt and pant. That way the objective ofthe game is to roll the dice and pick out the cow whoseclothes match the colour on the dice – there’s only onecolour that needs to matched and identified. Once theyare familiar with this I introduce the second dice. In theinitial stage I fix the second dice to a particular colour(say, yellow). Now they roll the other dice and pick outthe cows that are wearing clothes that match the colouron their dice + yellow. Gradually they learn to roll twodice and find the cow that matches the colours on bothdice.

Attending to stimuliThe game can be played in such a way that no matterwho rolls the dice, the person who is the fastest toidentify the cow gets to keep the card. It helps kids whotend to zone out during other’s turns to stay focused onthe game. Also, turns are decided based on who ‘moos’the loudest and fastest after the previous round hasended.

My kids find it incredibly funny and I see them trying toengage in a ‘Who Moos Louder’ contest with theirneuro-typical play partners!

ScanningAny version of the game requires good scanning skills.For example, the dice might show yellow and red. Thelearner must scan all the 21 cow cards (at least at thebeginning) to find the matching card. If your child findsthis too hard, you can start with one dice and six cards.

Shadow MatchingThe thinking cards have a set of shadows which matchwith the cow cards. It provides good practice for thekindergarten kids to pick out the correct card and can bequite challenging.

Two-step Listener RespondingSome of the thinking cards have visual instructions tofind a particular cow – for example, red + cake. So anadult or an older peer can read out the instruction and

the learner finds the cow that’s wearing red and holding acake. If the learner is motivated by the game, they aremore likely to engage in the listening activity.

One of my advanced language students also helped medevelop a variation to this game without using dice. Youcould take turns describing a cow card (for example, “thenext person for the party is wearing blue and holding aguitar”) and wait for the other player to find the picture.

Picture DescriptionSome of my kindergarten and early elementary studentslove to talk about the cow card that they pick up. Thecows are usually holding an object for the party orstriking a funny pose. It is a great idea to include picturedescription as part of the game for kids with intermediateor advanced language skills. You may also get to seethem imitate the funny pose!

Peer PlayThis game is a great option for peer play or play with asibling or older peer.

ProsThe different versions of the game make it possible toretain interest in the game for long. It is a great tool tofacilitate generalization of colour matching, scanning andlistener responding.

What I love best about this game is that it can be usedwith students with varying skill levels – all the way fromsingle colour identification and matching to picturedescription.

ConsThe cow cards are a little too small. Had they been thesize of the thinking cards, it would have been great. Thepurple and blue colours look similar and can be hard todistinguish between, but I must say some of my studentsdo it with great ease!

CostINR 299.You should invest in the game if there is an older siblingor peer who can play with the child with autism or if youare looking for motivating ways to generalize colourmatching and scanning skills.

* Maithri Sivaraman ([email protected]), BoardCertified Behaviour Analyst (BCBA), is a private ABAconsultant based in Chennai & works with families ofindividuals with Autism.


11

bl ys[k dk izdk’ku gekjh vkokt] vkWfVLe usVodZbUVjus’kuy dkaÝsUl VksjkUVksa ds O;k[;ku dh:ijs[kk gS vkSj ;g eq[;r% vkWfVfLVd cPpksa dsekrk&firk dks lEcksf/kr gSA

ekrk&firk dgrs gSa fd budk cPpk ^vkWfVfLVd* gS;g ckr muds lkFk gqbZ lcls ihM+knk;d ?kVuk gSAfcuk vkWfVLe vFkok lkekU; yksx vkWfVTe dks ,dcM+h =klnh dh rjg ns[krs gSa vkSj ,sls eka&ckivius vkWfVfLVd cPps vkSj ifjokj ds thou dkyds gj iM+ko ij yxkrkj fujk’kk o ek;wlh eglwldjrs gSaA

bl nq%[k dh mRifRr dk dkj.k flQZ vkWfVfLVdcPps dk thou esa vkuk ugha gSA ;g eka&cki dhmEehn fd;s gq, ,d lkekU; cPps ds u gksus@[kksusdk gSA vkWfVfLVd bUlku ds lkFk okLrfod thoudh tfVyrkvksa ds ctk; ekrk&firk dk utfj;k]vk’kk;sa vkSj ,d [kkl mej esa bl cPps ds fodklesa foHksn eq[;r% mudh ruko vkSj ihM+k dk dkj.kg S A

FkksM+h ek=k esa nq%[kh gksuk lkekU; gS D;ksafdeka&cki dks bl gdhdr dk lkeuk djuk iM+rk gS]fd ftl ?kVuk o lEcU/k dh oks vk’kk dj jgs Fksoks vlfy;r esa ugha gksxh] vkSj blds vuqdwy [kqndks cukuk iM+rk gSA ijUrq vius euksokafNr lkekU;cPps ds u gksus ds nq%[k ds izfr vuqHkwfr mUgsa] viusvkWfVfLVd cPps ls vyx j[kus dh t:jr gSA mlvkWfVfLVd cPps dks ftls O;ld dk;Zokgdksa ds lkFklqvolj feyus ij og ,d lkFkZd lEcU/k cukldrk gSA yxkrkj vius nq%[k dh tM+ dk dsUnz

vkWfVLe dks ekuuk eka&cki o cPps nksuksa ds fy,gkfudkjd gS vkSj ;g nksuksa ds chp esa Lohdkjrk vkSjfo’oluh; lEcU/k ukeqefdu dj nsrk gSA Lo;a dsfy, vius vkWfVfLVd cPps ds fy, ekrk firk dsle{k rhoz bPNk j[krk gwa fd oks vkWfVTe ds izfrvius n`f"Vdks.k esa tM+ ls ifjorZu yk;saA eSa vkidksgekjs vkWfVTe vkSj vkids nq%[k dks gekjs nf"Vdks.k lsns[kus ds fy, vkeaf=r djrk gwaA

vkWfVTe ,d yVdu@tksM+ ugha gSvkWfVTe fdlh O;fDr ds }kjk ,d tksM+h gqbZ oLrq ;kyVdu vFkok ,d dop ds vUnj Qalh gqbZ dksbZ phtugha gS u gh fdlh vkWfVfLVd cPps ds vUnj ,dlkekU;@uku&vkWfVfLVd cPpk Nqik gqvk gSA vkfVTevius esa ,d vyx thou gS ftldk viuk ,dvfLrRo gSA ;g cgqr O;kid gSA ;g thou ds gjvuqHko gj ,glkl] gj vuqHkwfr] gj fopkj] gjHkkouk] thou ds gj igyw ls lkeuk] mlds vfLrRolc ij viuh Nki NksM+rk gSA vkWfVTe dks fdlh dsvfLrRo ls vyx djuk eqefdu ugha gS] vkSj vxj,slk eqefdu gksrk rks vkids iz;Ru ds ckn ;gvkWfVfLVd O;fDr tks vkt vki ds ikl gS ml O;fDrls fcydqy vyx gksrk ftlds lkFk vkius 'kq:vkrdh FkhA

;g cgqr t:jh gS fd vki ,d {k.k dk le; ysdjbl ckr ij fopkj djsaA vkWfVTe dk vius esa ,dvyx vfLrRo gS vkSj vkWfVfLVd O;fDr dks mldsvkWfVTe ls vyx j[kuk eqefdu ugha gSA

blfy, tc eka&cki dgrs gSa %^^dk’k esjs cPps dks vkfVTe ugha gksrk** rks vlfy;r

gekjs fy, 'kksd u djsagekjs fy, 'kksd u djsagekjs fy, 'kksd u djsagekjs fy, 'kksd u djsagekjs fy, 'kksd u djsafte feuDySjfte feuDySjfte feuDySjfte feuDySjfte feuDySj

vuqokn & iwtk [kUuk vuqokn & iwtk [kUuk vuqokn & iwtk [kUuk vuqokn & iwtk [kUuk vuqokn & iwtk [kUuk


13

fdlh iwoZ dYiuk vkSj ,d [kqys fnekx ls ubZphtsa lh[kus dh vfHkyk"kk ds lkFk tk;s rcvkidsk ,d ,slh [kwclwjr nqfu;k fn[ksxh ftldhvkius dHkh dYiuk Hkh ugha dh gksxhA

gk¡! blesa vkWfVLfVd cPps ds lkFk lEcU/k cukus esauku&vkWfVLfVd cPps ds eqdkcys cgqr T;knk dkedjuk iM+rk gSA ij gka ;g rHkh eqedhu ugha gStc gekjs ukWu vkWfVfLVd eka cki ds lEcU/k cukusdh {kerk gels Hkh de gSA ge rks iwjk thou flQZvki yksxksa ls lEcU/k vkSj fj'rs cukus esa fcrk nsrsgSaA ge esa ls gj ,d tks vki yksxksa ls FkksM+k Hkhcksyuk lh[k ysrk gS ge esa ls gj ,d tks FkksM+kHkh vkids lekt ds fglkc ls vius dks lapkfyrdj ysrk gSA ge esa ls gj ,d tks vkidh vksjdne c<+kdj ,d cU/ku cukrk gS og ,d vijns'kh o vutkus bykds esa dke dj jgk gS vkSjvUtkus yksxksa esa gh fj'rk cu jgk gSA vkSj geviuh iwjh ftanxh bl lEcU/k dks cukus esa yxknsrs gS vkSj fQj vki dgrs gSa fd ge lEcU/k ughcuk ldrsA

vkvkvkvkvkWW WWWfVTe e`R;q ugha gSfVTe e`R;q ugha gSfVTe e`R;q ugha gSfVTe e`R;q ugha gSfVTe e`R;q ugha gSekuk fd fdlh Hkh u;s cPps dh mEehn dj jgsekrk firk dHkh Hkh vkWfVfLVd cPps dh vk'kk ughadjsaxsA oks ,d ,sls cPps dh mEehn djsaxs tks mudstSlk gks vkSj muds tSls gh nqfu;k ns[ks vkSj le>ys vkSj fd mUgsa vkthou ml vtuch cPps dksizf'k{k.k ughsa nsuk iM+sA

vkWfVTe ds vykok vU; fodykaxrkvksa esa Hkh ekacki cPpss ds lkFk mUgha 'krksa Z ij lEcU/k cukukpkgrs gSa tks muds utfj;s esa lkekU; gksrk gSA vkSjvdlj vU; fodykaxrkvksa esa dfe;ksa ds ckotwn oksdqN gn rd vius cPpksa ls viuh vk'kk vuqlkj,d tksM+ cuk gh ysrs gSaA ij ,d vkWfVfLVd cPpsds lkFk bl rjg dk cU/ku Hkh lEHko ugha gksrkAT;knkrj eka cki dh ek;wlh dk dkj.k mudhvk'kk vuqlkj ml vkWfVfLVd cPps ls ftlds

lkekU; gksuh dh mUgksaus mEehn dh Fkh mllslEca/k dk u cuuk gSA

;g nq[k ,d cgqr cM+h lPpkbZ gS vkSj mldkfuokj.k djuk t:jh gS ftlls yksx viuh ftUnxhth ldsA

ij bl nq[k dk vkWfVTe ls Hkh dksbZ rkYyqd ughagSA vly esa gksrk ;g gS fd vkius vR;f/kd :i lsfdlh egRoiw.kZ pht dhs vk'kk dh gS vkSj mldkcgqr [kq'kh vkSj tks'k ls bUrtkj dj jgs gks vkSj'kk;n dqN iy ds fy;s vkidks yxs fd oks [kq'khvkidks fey Hkh x;h gSA ij fQj 'kk;n /khjs ls]'kk;n vpkud vkidh igpku esa vk;k fd ftldkvkius vHkh rd bruk bUrtkj fd;k Fkk oks u gqvkgS vkSj u vkxs dHkh gksxkA vkids pkgs vU; ftrusHkh lkekU;@ uku vkWfVLfVd cPps gks tk;s blrF; dks vki dHkh ugha cny ikrs fd bl ckjvkius viuh ;kstuk vuqlkj ftl cPps dh vk'kko mEehn djh o lius ns[ks oks vkidks dHkh ughaf eykA

;g Bhd mlh izdkj dk vuqHko gS tks ,d eka ckidks ,d e`r f'k'kq iSnk gksus ij gksrk gS ;k mudkscPps dks cgqr gh de nsj ds fy, idM+us dk ekSdkfeyrk gS oks cpiu esa gh ijyksd fl/kkj tkrk gSA;g ckr vkfVTe gksus dks ugha gSA ;g vk'kkvksa dspwj&pwj gksus dh gSA eSa ;g lykg nsrk gw¡ fd budk fuokj.k djus ds fy, lcls lgh txg vkWfVTelaLFkk u gksdj vkWfVLfVd cPpksa ds eka cki }kjkfey dj cuk;s x, enn vkSj lykg ds xzqi gSaA

,sls yksxksa ds chp eka cki vius bl nq[k dksLohdkjus esa T;knk leFkZ gksrs gSaA bl nq[k dksHkwyus ds fy;s ugha ijUrq bldks ,d chrh ?kVuk dhrjg ysus ds fy, ftlls fd ;g nq[k mUgsa thou dsgj {k.k esa ijs'kku u djsA oks bl ckr dksLohdkjuk lh[k tkrs gSa] fd mudk cPpk tk pqdk


12

esa ;g dg jgs gSa fd **esjh bPNk gS fd esjk ;gvkWfVfLVd cPpk u jgs vkSj blds cnys esjs ikl ,dvyx @lkekU; cPpk gks**A

bls fQj ls i<+sA gesa ;gh lqukbZ nsrk gS tc vki gekjsthou ij 'kksd eukrs gSaA gesa ;gh lqukbZ nsrk gSA tcvki gesa vkWfVTe uke ds jksx ls eqDr djus ds fy;snqvk;sa ekaxrs gSaA gesa ;gh le> vkrk gS tc vki gesagekjs fy;s ns[ks viuh lcls I;kjh vk'kkvksa vkSj liuksads ckjs esa crkrs gSa vkSj ;g fd vkidh lcls cM+hbPNk gS fd gekjk vkWfVTe dk vfLRro [kRe gks tk;svkSj vki fQj gekjs psgjs ds Hkhrj fNis uku &vkWfVLfVd cPps ls I;kj dj ldsA

vkWfVTe ,d vizos'kh; nhokj ugha gSvkWfVTe ,d vizos'kh; nhokj ugha gSvkWfVTe ,d vizos'kh; nhokj ugha gSvkWfVTe ,d vizos'kh; nhokj ugha gSvkWfVTe ,d vizos'kh; nhokj ugha gSvki cPps ds lkFk O;kogkj cukus dh dksf'k'k djrs gSavkSj oks vkidks mÙkj ugha nsrk gS oks vkidks ns[krkugha gSA vki ml rd iqgap ugha ik jgs gSaA dksbZrjhdk mls le>us dk ugha fn[k jgk gSA ;gh lclsdfBu pht gS tks vkids lkFk gks jgh gS ij vly esa;g lR; ugha gSA bl iwjh izfrfØ;k dks fQj ls ns[ksaxkSj djsaA

vki vius vkWfVLfVd cPps ls ,d lkekU; cPps ds izfrviuh le>] Loa; ds ykyu ikyu dh Hkkouk;sa] fj'rksads ckjs esa vius rtqjcs vkSj vUrjKku ds fglkc lsfj'rk cukus dh dksf'k'k djrs gSaA vkSj vki dk cPpkfdlh Hkh mijksDr ekin.M ds fglkc ls ftls vkiigpku ldsa [kjk ugha mrjrk gSA

ijUrq bldk ;g eryc ugha gS fd cPpk fdlh izdkjls lEcU/k cukus esa l{ke ugha gSA bldk flQZ ;geryc gS fd vki ,d ,slh lgHkkxh vkilh rkyesyO;oLFkk dh dYiuk dj jgs gSa & tks vkilh lgHkkxhladsrksa dh le> vkSj eryc dks tkurk gks tks vkidkcPpk le> gh ugha ik jgk gSA ;g Bhd mlh izdkj gStSls fd vki fdlh ds lkFk cM+h vUrjK ckrs dj jgsagS vkSj mls vkidh Hkk"kk dk dksbZ Kku gh ugha gSAtkfgj gS muls vki fdl ckjs esa ckr dj jgs gSa

fcYdqy le> ugha vk;sxk vkSj mldk tokc fcYdqyvkidh vk'kk ds foijhr gksxkA vkSj gks ldrk gS mls;g ikjLifjd laidZ cukus dh fØ;k cM+h cqjh ovLi"V yxsA

fdlh Hkh izdkj dh ikjLifjd laidZ fØ;k tgka nwljsO;fDr dh ewyHkk"kk vkils vyx gSA mlesa T;knkijhJe yxrk gS vkSj fQj vkWfVTe rks Hkk"kk vkSjLkH;rk ls Hkh xgjk gSA vkWfVfLVd yksx gj lekt dsfy, ,d ijns'kh gh gS vkidks viuh bl dYiuk dkscnyuk gksxk fd vki vkSj vkids cPps dh le> dsekin.M ,d gh gSA vkidks bruh cqfu;knh Lrjksa ijokil tkuk gksxk tks vkius dHkh lksph Hkh u gksaxhAphtksa dk vuqHko vius cPpksa ds fglkc ls djuk gksxkA

vkSj ;g tkapuk gksxk fd vkidk mls le> vk jgk gSfd ughaA vkidks vius ifjfpr {ks= dh fu'fpfrrkNksM+uh gksxhA vkidks vius cPps dks mls viuh Hkk"kkfl[kkus dk ekSdk nsuk gksxk ftlls oks vkidk viusvkWfVfLVd thou esa ekxZn'kZd cusA vFkkZr oks vkidkf'k{kd cudj viuh nqfu;k esa vkidk inkZi.k djsa vkSjvxj bu urhtksa esa vki lQy gks x;s fQj Hkh ;g,d lkekU; ¼uku&vkWfVLfVd½ cPPks vkSj mlds eka ckitSlk lEcU/k ugha gksxk tks ckr djuk lh[k ysxk ,dlkekU; cPpksa okys fo|ky; esa tk;sxkA 'kk;n dkWystesa Hkh xkM+h pyk;sxk] Lora=rk ls jg ysxk viuhthfodk gksxh ij og dHkh Hkh vkils ,d lekU;bUlku dh rjg laca/k ugha cuk ik;sxkA ;k ,slk Hkhgks ldrk gS fd vkidk vkWfVfLVd cPpk dHkh u cksys],d fo'ks"k dsUnz ls Lukrd gksdj ,d lqjf{kr xfrfof/k;k vkokfld lgwfy;r okyh txg jgs] iwjs le;ns[kHkky vkSj fujh{k.k pkfg, gks ij fQj Hkh oksvkidh igqap ls ckgj ugha gksxkA ge ftu vyx vyxrjhds ls lEca/k cukrs gSa ;g lc ml ij fuHkZj gS vkitksj nsdj mu phtksa ds fy, tks vkidh vk'kkvksa dsvuq:i gS o vkidks lkekU; o lgh yxrh gS ds fy,vius vkWfVfLVd cPps ls LkEcU/k cukus dh dksf'k'kdjsaxs rc vki dqafBr grk'k ukjkt 'kk;n xqLlk vkSjuQjr eglwl djsaxsA vki muds ikl bTtr ls] fcuk


14

gS vkSj oks dHkh okil ugha vk;sxkA mlls HkhT;knk egRoiw.kZ gS mudk ;g lh[k tkuk fd mUgsavius [kks;s gq, cPps ds nq[k dks vius thfor cPPksij gkoh ugha gksus nsuk gSA ;g rc vkSj Hkh t:jhgks tkrk gS tc u;k thou ml le; tUek gks tcge vius xqtjs gq, cPps dk 'kksd euk jgs gSaA

vkius cPps dks vkWfVTe ds rgr ugha [kks;k gSAvkius mldks blfy, [kks;k gS D;ksafd ftl cPpsdh vkidks vk'kk o bUrtkj Fkk oks rks vk;k ghugha blesa ml vkWfVLfVd cPps ds thou dk dksbZnks"k gh ugha gSA vkSj vkids bl nq[k dk cks>gekjs mij ugha gksuk pkfg,A gesa ,sls ifjokjksa dht:jr gS vkSj ge ,sls ifjokjksa ds ;ksX; gSa tks gesans[ks a gekjh dnz djsa u fd ,sls ifjokj ftudh/kqa/kyh n`f"V ,slh ijNkbZ ds fy;s gS tks dHkh Fkhgh ughaA vki 'kksd euk;sa] ij vius [kks;s gq,liuksa ds fy, u fd gekjs fy,A ge ftUnk gSAvc thrh tkxrh vlfy;r gSA vkSj ge vkidkbartkj dj jgs gSaA

esjs n`f"Vdks.k ls bUgha ckrksa ij xkSj djus ds fy,vkWfVTe lekt gksuk pkfg,A u fd bl ckr ij'kksd eukus ds fy, tks gS gh ugha] ij ml phtdks vPNs ls le>us dk tks vlfy;r gS gesa mldht:jr gSA gesa vkidh enn vkSj gesa le>us dht:jr gSA vkidh nqfu;k gekjs fy;s cgqr [kqyhugha gS vkSj gekjk blesa thou;kiu djuk vkidhenn ds fcuk lEHko ugha gSA vkWfVTe ds lkFk ,d=klnh t:j vkrh gS ij gekjs dkj.k ugha cfYdblfy, tks gekjs lkFk gqvk gS vkSj vki bl ckrij nq[kh gks vxj vkidks fdlh ckr dk nq[k ghekuuk gS rks ij nq[kh vkSj 'kksdk;qDr gksus lscsgrj gS fd vki bl ckr ls brus ikxy gks tk,vkSj blds fy, dqN lkFkZd dj MkysaA nq'okUr?kVuk gekjk vkWfVLfVd gksuk ugha gS cfYd blnqfu;k esa gekjs fy, dksbZ txg u gksuk gSA vkSjtxg gks Hkh dSls ldrh gS tc gesa bl nqfu;k esa

ykus okys gekjs vius ekrk firk gekjs thou ij'kksd cuk jgs gSaA

vki ,d utj vius vkWfVfLVd cPps ij Mkys vkSj,d feuV [kqn ls ckr djs fd og cPpk D;k ughagSA [kqn ls lksaps ;g esjk ;kstukc} o vk'kk fd;kgqvk cPpk ugha gSA ;g oks cPpk ugha gSA ftldkeSaus viuh dks[k esa 9 eghus bUrtkj fd;k vkSjmlds iSnk gksus esa fdrus ?kUVksa dh izlo ihM+klghA ;g oks cPpk ugha gS ftlds fy, eSaus fdruh;kstuk;sa cuk;h vius rtqZcs ckaVus dhA oks cPpk rksvk;k gh ughaA ;g oks cPpk gS gh ughaA

fQj tk;s vkSj tks dqN 'kksd eukuk gS euk;s] viusvkWfVfLVd cPps ls nwj tkdj vkSj phtksa dks mudsgky ij NksM+uk lh[kuk 'kq: djsaA

tc vkius phtksa dks Lohdkjuk 'kq: dj fn;k gksokil vk;s vkSj vkius vkWfVfLVd cPps dks fQj lsns[ksa vkSj [kqn ls dgsa ;g esjk vk'kk fd;k gqvk;kstuk c} cPpk ugha gSA ;g ,d nwljs xzg dkcPpk gS tks xyrh ls esjh ftanxh esa vius izdkj ds[;ky j[kus okys eka cki ds fcuk vk x;k gSAeq>s ugha irk fd ;g dkSu gS ;k bldk vkxs D;kgksxkA ij eq>s irk gS ;g ,d vtuch nqfu;k esafcuk eka cki ds HkVdrk gqvk cPpk gSA bls i<+k;smlds fy, mldh O;k[;k djus okyk vkSjvfHkoDrk cusaA vkSj D;ksafd ;g nwljs xzg dk cPpkesjh ftUnxh esa vk x;k gS rks ;g dk;Z esjk gS vxjeqq>s bl cPps dk lkFk pkfg,A

vxj ;g lEHkkouk vkidks tkx`r djrh gS rc vkigekjk lkFk etcwrh vkSj n<+ fu'p; esa vk'kk vkSj[kq'kh ls nsaA

iwjh ftUnxh ds lkgkfld dk;Z dk chM+k mBkuk vkidsvkxs gSA


15

E L LH ENIP

Q My daughter, H, is twelve years old. I am having alot of difficulties with her toilet training. She doesn’tindicate at all when she wants to go to the toilet. Evenif I take her to the toilet at regular intervals, for most ofthe times, she doesn’t do her job there. Sometimes shestands up from the pot and does it standing withinseconds just over there. Sometimes she comes out ofthe toilet and does her job after a few minutes. I havekept a record of her timings for a month and tried totake her as per those timings. But her schedule varies.Sometimes she does it more frequently whereas onother days there are long gaps. Sometimes shecooperates for the whole day. For the past two weeks Iam noticing that she starts jumping and laughing beforedoing her job, but I am not sure if it she is using this tocommunicate her toileting needs. Please help.

A Thank you for sharing your concern about H. Weappreciate your desire to teach H to relieve herself inonly the toilet and also to indicate her need to urinateand defecate well in advance, to avoid accidents.As with any other skill, toileting too needs to be taughtgradually in steps. Independence in this very complexself help skill involves control over physical,physiological, cognitive and sensory processing andgeneralise the same in different situations.

When teaching a child to void oneself at the appropriateplace i.e. the toilet, it is first important for the child tohave the ability to recognize the sensation of needing torelieve oneself, an area of difficulty for a large numberof children with autism (almost 98%, according to anAmerican study). Just like one associates that ‘hollowfeeling’ in the stomach with hunger, we also recognizethat the heavy feeling of discomfort in the lower part ofthe stomach, indicates the need to urinate or defecatedepending on the particular sensation. Our body has theinteroceptors which help us to recognize this sensationand since these receptors (sensation recognizingconnections) are present internally in our body, teachingthe child how to recognize these messages may be a bitdifficult and may involve actually creating the sensationwithin the body. For instance, one can give the childplenty of fluids, in an effort to replicate the heaviness inthe lower abdomen signalling a full bladder and hence‘feel’ the need to urinate.

From your description, it seems that H does recognizethe sensation to relieve herself occasionally and alsohas the physical skill to perform the job. This means weneed to use strategies to teach her to consistentlyrecognize this sensation and also learn to relieve herselfin the appropriate place.

When doing so, schedule training or taking the child tothe toilet at regular pre determined intervals, is veryeffective. But taking the child to the washroom toofrequently may not be a good idea, because that wouldcome in the way of the building the capacity of bladdermuscles to retain urine which in turn leads to bettercontrol. Taking her at too short a duration will reducechances of accidents but will not help her to build thecontrol or to learn to control the need to voiduntil takento toilet. Instead finding the optimal time to her to thetoilet would be more effective.

You are already taking H to the toilet at regularintervals based on the data that you have collected for amonth observing the times at which she relieves herself.However, you have also mentioned that to her toiletschedule tends to vary. Have you noticed anythingdifferent about those days? For instance, on the days sheurinates more frequently, has she drunk more fluids, isit less warm/ cooler than other days? Or on the daysthat she is urinating at longer gaps, has she beensweating more? These may help you vary the times atwhich you take H to the toilet, varying her toiletschedule as per her needs.

Keeping this in mind, you could start taking H to thetoilet and help her sit on the toilet seat every 60 to 90minutes, so that she learns that she can relieve herselfonly at a specific place, ie in the toilet, when she sittingon the pot. When she is sitting on the pot, you may wantto talk to her, praise her for sitting well, so that thesitting on the pot, per se, becomes a positiveexperience.

You can give her something to hold on to or a toy toplay with when she is sitting on the pot to help her sitbetter, unless you feel that this may distract her fromdoing the job. And when she has relieved herself,remember to praise her BIG and praise her specifically


17

Date: 21-23 September, 9 am – 5 pm • Venue: The National Centre For Autism, New Delhi

UPCOMING WORKSHOPS

Dates: 25-26 November 2016 Venue: India International Centre, New Delhi

Action For Autism brings you the rare opportunity tolearn with Professor Tony Attwood.

Prof Attwood is recognised internationally as one of theleading specialists in Autism Spectrum Disorders,especially the high functioning end. He has authoredseveral books including Asperger’s Syndrome – A Guidefor Parents and Professionals which has sold over350,000 copies and has been translated into over 25languages. His subsequent book, The Complete Guide toAsperger’s Syndrome, is one of the primary textbookson Asperger’s syndrome.

Prof Attwood is regularly invited as a keynote speakerat International Conferences. He presents workshopsand runs training courses for parents, professionals andindividuals with Asperger’s and High FunctioningAutism all over the world. He has worked with manythousands of individuals of all ages. He is adjunctprofessor at Griffith University, Queensland and seniorconsultant at the Minds and Hearts clinic in Brisbane.

Know Me Teach Me

Asperger’s Syndrome & High Functioning AutismTraining by Tony Attwood

For more information, Email: <[email protected]>or Call us on <+91 99531 13208; +91 11 4054 0991-92> orvisit our website:<www.autism-india.org>

Over the course of two days, the training will focus onissues across the lifespan, especially strategies to: - Make friends- Improve social understanding and

relationships- Reduce being bullied and teased- Build upon cognitive abilities- Manage feelings and facilitate

emotion management- Sustain employment

Who Should Attend?Parents, family members, relatives, educators,clinicians - anyone wanting to understand more aboutAutism Spectrum Disorder and how to support childrenand adults with an ASD.

“Is he really autistic ?“Can he really study?”

“Why does he not learn like other kids? Why doesn’t he play with other kids?”

“Why is he so rude?!”“Can he get married?”

If you have any such questions, this workshop is for YOU!

Annual Training Workshop

Early Bird Registration ends on 3 September 2016



16

‘Good doing your job in the pot!’ You can also give Hsomething that she likes a lot - a toy, an edible, music,anything that will help her remain motivated to relieveherself in the toilet.

On the occasions that she does not void, instead ofcoercing her to sit on the toilet seat for a long durationand insist that she urinates, it may more advisable to lether go after she has been sitting for a couple of minutesand then bring her back to the toilet after a short while.This would ensure that the experience of sitting on thepot remains positive. Praising her specifically- ‘Goodsitting on the pot’ will also help keep this experiencepositive. Do remain focussed at this point of time toavoid accidents and take H to the toilet frequently tillshe relieves herself. And when she does eventuallyvoid, as mentioned earlier, do remember to praise herspecifically, as well as give her something that shelikes. And once she voids, you can once again revertback to the 60/ 90 minute schedule.

In the event that an accident does happen, please do notget disheartened. Instead clean her up without giving thebehaviour any attention and staying emotionally neutral.

You have mentioned that sometimes H has startedlaughing and screaming and you are not sure if she istrying to indicate her need to go to toilet through thisbehaviour. We would suggest that you do not take her totoilet ONLY at the times when she shows thisbehaviour because by doing this, you will in effect beteaching her that she can indicate/ communicate for hertoileting needs by laughing and screaming. Taking herto the toilet consistently and regularly, even when she isnot exhibiting challenging behaviours like jumping andlaughing will increase the chance of success ofrelieving herself in the toilet.

When you say that ‘sometimes she does it in standing’,have you noticed anything different at these times?Does this happens when she is not going into her usualtoilet or when the toilet is wet or she has to go bare feetor if she is doing with a specific person/s like only withyou (which could be her way of getting attention)? Forsensory challenges, try simple strategies like placing astool under her feet (if you feel her feet are dangling)and/or letting her support herself against the wall (if youfeel additional support would add to comfort) and/orwear slippers while entering the toilet (if a wet floor/cold feel of the toilet floor may cause discomfort). Alsoprepare her beforehand if, at home, she has to useatoilet different from the one that she usually uses or

when she may have to use a toilet when she is not athome. Should you notice that she is doing this with aspecific person/s, it is very important that she gets noattention for the accident, but, instead at all other timeswhen she is doing something appropriately, includingrelieving herself in the toilet, she gets a LOT ofattention.

When teaching H to recognise the ‘discomfort’associated with the need to defecate or register thesensation, you can make her sit on the toilet seat everyday at fixed time, preferably after meals when herstomach is full and passing stools is easier. You coulddo the same when you notice a sign of discomfort or agesture suggesting that she needs to defecate.

We need to remember that oftentimes children withautism suffer from constipation and infrequent bowelmovements. Limited diets due to food preferences, aswell as sensory issues may further aggravate theproblem. Introducing healthy food with enough fiber insmall portions is a good idea. Getting a child used to anew diet will take time, but consistency is the key tosuccess. We need to remember that changing the child’sfood habits also means changing the food habits of theentire household, which though difficult, is notimpossible! And to also remember that such adaptationsfor the entire family need not be for a lifetime, but, onlytill the child has got used to a somewhat balanced dietand has a more regular bowel movement.

Giving visuals as reminders, as well as social stories tohelp the child understand where it is appropriate torelieve oneself is always advisable. Also do ensure thatH has free access to the toilet whenever possible andthat in new places you always show her where the toiletis. Further, help H perform the task in a ‘sociallyappropriate manner’, with teaching her to close the doorof the toilet when she is using it and undressing ordressing ONLY inside the toilet. Slowly start workingon generalization by encouraging H to use the bathroomin different settings like the school, relatives’ house,malls etc. And, most importantly, as when teaching anyskill, do remember to reinforce every small effort thatH makes.

Once H has achieved a degree of success in relievingherself in the toilet and there are far fewer accidents, itwould be important for you to start teaching her to

(...cont on Pg 18)


17

Date: 21-23 September, 9 am – 5 pm • Venue: The National Centre For Autism, New Delhi

UPCOMING WORKSHOPS

Dates: 25-26 November 2016 Venue: India International Centre, New Delhi

Action For Autism brings you the rare opportunity tolearn with Professor Tony Attwood.

Prof Attwood is recognised internationally as one of theleading specialists in Autism Spectrum Disorders,especially the high functioning end. He has authoredseveral books including Asperger’s Syndrome – A Guidefor Parents and Professionals which has sold over350,000 copies and has been translated into over 25languages. His subsequent book, The Complete Guide toAsperger’s Syndrome, is one of the primary textbookson Asperger’s syndrome.

Prof Attwood is regularly invited as a keynote speakerat International Conferences. He presents workshopsand runs training courses for parents, professionals andindividuals with Asperger’s and High FunctioningAutism all over the world. He has worked with manythousands of individuals of all ages. He is adjunctprofessor at Griffith University, Queensland and seniorconsultant at the Minds and Hearts clinic in Brisbane.

Know Me Teach Me

Asperger’s Syndrome & High Functioning AutismTraining by Tony Attwood

For more information, Email: <[email protected]>or Call us on <+91 99531 13208; +91 11 4054 0991-92> orvisit our website:<www.autism-india.org>

Over the course of two days, the training will focus onissues across the lifespan, especially strategies to: - Make friends- Improve social understanding and

relationships- Reduce being bullied and teased- Build upon cognitive abilities- Manage feelings and facilitate

emotion management- Sustain employment

Who Should Attend?Parents, family members, relatives, educators,clinicians - anyone wanting to understand more aboutAutism Spectrum Disorder and how to support childrenand adults with an ASD.

“Is he really autistic ?“Can he really study?”

“Why does he not learn like other kids? Why doesn’t he play with other kids?”

“Why is he so rude?!”“Can he get married?”

If you have any such questions, this workshop is for YOU!

Annual Training Workshop




If undelivered please return to:The Editor, Autism Network,

Pocket 7&8, Jasola Vihar, New Delhi - 110025

B O O K P O S T

18

Published & printed by Merry Baruaon behalf of Action for Autism (AFA) from

Pocket 7&8, Jasola Vihar, New Delhi - 110025

Tel: 91 11 40540991, 91 11 65347422Email: [email protected]

Website: http://www.autism-india.org

Printed at:Naveen Printers

F-11/B Okhla Industrial Area Phase I,New Delhi - 110020

Tel: 26814680 / 40523313

Editor: Merry Barua

(RNI No. DELBIL/ 2006/ 23172DELBIL/ 2006/ 23172DELBIL/ 2006/ 23172DELBIL/ 2006/ 23172DELBIL/ 2006/ 23172)

indicate her need to go to the toilet using the mode thatshe uses to request/ communicate for her other needs.You can teach her to use a sign or exchange an object/photograph/ picture card or say the word ( if she hasvocals) consistently before you take her to the toilet.

We hope that you will find some of these strategiesuseful. Please remember not to turn this into ‘battle ofwills’ and that H does not use the toilet training task asa way to control you and the other caregivers. We wishyou the best in your journey ahead.

This helpline question has been answered in conjunctionwith Dr Anjali Joshi. Dr Anjali Joshi is a practisingoccupational therapist, trained in S. I. and you cancontact her [email protected]

REFERENCES

1. Building bridges through sensory integration byEllen Yack, Shirley Sutton, Paula Aquilla.2. A Work in Progress: Behavior ManagementStrategies & A Curriculum for Intensive BehavioralTreatment of Autism by Ron Leaf, John McEachin,Jaisom D. Harsh.3. Potty training for children with autism or intellectualdisabilities. Developmental Information and PracticalProcedures by Sue Bettison.

(...cont from Pg 16)

august 2016 vol. 11 issue 2 - action for autismautism-india.org/sites/default/files/august...

Documents