Introduction

Tolerance

Tolerance is a relevant topic in autism: Children on the autism spectrum may have inflexibilities or strong preferences (sensory related challenges, rigidities etc.). Some examples of challenges are haircuts, going to new places, or trying new foods. 

 

Prerequisite skills: Ability to cooperate, specifically: 

  • Follow First Then instructions
  • Comply to Basic Instructions
  • Follow a Visual Schedule
  • Some Functional Communication 

 

3 Key Learning Strategies:

  1. Break Skills Down
  2. Pair with Reinforcement
  3. Provide Sufficient Practice 

 

Reminder: we focus 90% of our efforts on Preventative and Teaching Strategies 

Systematic Desensitization

A method in which an individual is “gradually exposed to an anxiety-producing object, event, or place while being engaged in some type of relaxation at the same time in order to reduce the symptoms of anxiety.” (Study.com, 2015)

 

Look out for behaviours indicating that a child is anxious and struggling to tolerate something: covering their eyes and ears, rejecting or pushing away, trying to leave the table, heightened self-stimulatory behaviours etc. (autismspeaks.org, n.d.)

5 steps to build a child’s tolerance:

1. Communicate expectations 

  • Break down the skills and communicate expectations via Social Stories, Video Models and Visual Schedules.
  • Note: The visuals are potentially anxiety-producing for your child. 

 

2. Probe

  • Present expectations (items/event) without any specific demands
  • Child is required to tolerate facing the situation/item
  • Model and demonstrate the expectation, either on yourself/a little doll/another child, peer or adult
  • Usually done in addition to Video Model, to let a child see the real-life practice and hopefully be more willing to try it his or herself

 

3. Practice 

  • Gauge which parts are less challenging and which are more challenging
  • Practice to build up their duration tolerating the object, place or environment
  • Can start from as short as a few seconds and up to hours
  • The systematic increase of challenge can be individualized according to each child’s needs, usually focusing on one specific aspect at a time

 

4. The BIG Day 

  • Refers to the actual event/real moment: e.g. the day your child actually goes for a proper haircut, or has a birthday party
  • Everything done in Stage 3 is to prepare for the Big Day
  • Ensure your child is as properly prepared as possible 
  • Have your visuals with you, reinforcement and reactive strategies in case it does not work out well 

 

5. Review, Generalize or Troubleshoot 

  • If The Big Day is successful -> fantastic! Start working on generalization in different locations or different people (increase challenge)
  • If The Big Day was not so successful -> it’s alright, go back to the drawing board, and review which part was challenging
  • If challenging behaviours happened during The Big Day, it is just your child communicating that he/she is unable to tolerate that step yet, and we need to simplify it further, provide more practice and perhaps use stronger reinforcement.
  • Go back to Stage 3 and build up practice and systematic desensitization again to prepare for the next Big Day! 

Your Turn:

Check which of the following are the challenges your child currently faces:

  • Hair Cutting
  • Nail Cutting
  • Separation from Parents
  • Loud Sounds
  • Crowds & New Places
  • Birthdays 

 

There are many more tolerance areas, so do feel free to add on additional areas of tolerance that may be a bigger priority to you and your family!

Discuss with your family members on which area to focus on first with your child.

References

1. Study.com (2015). Systematic Desensitization: Definition, Treatment & Examples. Retrieved April 27, 2022, from https://study.com/academy/lesson/systematic-desensitization-definition-treatment-examples.html
2. Autism Speaks. (n.d.). Sensory issues. Retrieved April 27, 2022, from https://www.autismspeaks.org/sensory-issues