On the 5th of October 2019, we held our EAP Public Workshop, on the topic of ‘Autism At Home.’ This workshop was presented by our very own Jochebed Isaacs, Clinical Psychologist and the Director of EAP Malaysia. Jochebed was trained as a supervisor at our parent company, Wisconsin Early Autism Project, and has worked with hundreds of children with autism in Malaysia, USA, Perth, as well as Singapore. She has trained parents, teachers, therapists and professionals on a variety of topics on autism and Applied Behavioural Analysis (ABA) to develop new skills and positive behaviours in individuals with autism.

This workshop was held at HELP University ELM Business School, with members of the public in attendance, as well as our own EAP Team. We also had special guests from the ‘Program Pemulihan Dalam Komuniti’ (PDK)’ who attended the workshop!

In today’s blog article, we would like to share with you snippets from the presentation and key effective strategies that you can take away and apply in your very own home!

Autism and What Parents Should Know

To begin, it would be important to understand that because autism is a spectrum, children on the spectrum have the ability to learn, but each of them will learn at different rates. Here are a few key information that parents should know about their children, such as:

• Monitoring their child’s developmental milestones and the importance of early identification
• Identifying their child’s developmental age (i.e. the child’s mental age instead of their actual chronological age)
• Determining the likely prognosis for their child based on some early indicators, the child’s current age, skill gap and rate of learning 
• Identifying their child’s priorities for learning and the best strategies to teach their child new skills

Key Effective Strategies

In supporting children with autism and helping them develop new skills, the principles of Applied Behavioural Analysis (ABA) is currently the gold-standard treatment approach for autism. Based on the principles of Operant Conditioning, consequences have an impact on increasing or decreasing behaviour. Hence, it would be important to:

• Reward behaviours you want to increase
• Extinct (ignore) behaviours you want to decrease

Utilising The Principles of ABA

When teaching children with autism new skills and concepts, the 3 basic principles of Applied Behavioural Analysis (ABA) are:

1. Breaking skills down to its component parts
2. Pairing new skills with positive reinforcement
3. Providing sufficient practice

Some important foundational skills and pre-requisites that children with autism should learn include:

1. Rapport, engagement and motivation
2. Attention
3. Imitation
4. Cooperation
5. Receptive Understanding
6. Functional Communication

Autism At Home

Some of the common challenges that families/parents may face with individuals with autism could include behaviours (e.g. aggressive, self-injurious, or self-stimulatory behaviours), difficulty in communicating and understanding the child’s needs, non-compliance and teaching the child with autism to occupy their time meaningfully. 

To support individuals with autism at home, the following key strategies can be applied:

1. Setting up the home to be successful
2. Establishing a structure at home and teaching the child to play independently
3. Teaching the child how to communicate functionally
4. Teaching the child to cooperate/comply

Setting Up The Home To Be Successful

In order to ensure that the home environment is successful for children with autism, it would be important for parents to consider the aspects of the child’s safety, independence, specific needs and play stations.

To ensure a safe environment for children with autism, some helpful tools could include baby gates, safety plugs, table corners, door stoppers, anti-slip staircase, anti-slip bathroom mats, tempered glass, as well as locked windows and doors. Parents should also be mindful for breakable and expensive items around the house, and to be extra cautious whenever their child is nearby high-risk areas such as the swimming pool, balcony and roads.

To promote independence with routines, parents could utilise different visual schedules for different routines (e.g. toilet time schedule, meal time schedule, shower time schedule) to effective communicate expectations to children with autism. Additionally, for the toileting routine, parents could obtain a child-sized toilet seat and step stools, so that their child can perform the routine as independently as possible with minimal assistance from an adult. 

To teach children how to occupy themselves meaningfully and independently during their free time at home, parents could set up different play stations at different corners of the house. Some examples of play stations could include book corners, kitchen set, tool set, water or sensory table, etc. 

For children with autism who may have specific sensory needs, parents could even equip their home with items such as a trampoline, bean bag, crash pad, gym mats or even a climbing wall to create a type of gym room in their home, so that their children can easily access these items in order to have their sensory needs met in an appropriate and safe manner.

Establishing Structure At Home

It would be important for parents to establish a clear routine and structure at home for their child with autism, as unstructured and unoccupied free time gives opportunity for children with autism to participate in self-stimulatory or other challenging behaviours. Below is an example of a daily structure that parents can implement at home:

Functional Communication

One of the core priorities for children with autism is to teach them how to communicate functionally, whether through speech, pictures of the use of alternative methods. According to the creators of the Picture Exchange Communication System (PECS), critical communication skills that every child should learn include:

As communication is bi-directional, it is crucial that the adults/parents/caregivers communicate to children with autism in a manner that they can understand best – and this can commonly be achieved through the use of visuals and short phrases.

Some examples of visuals that we would recommend for parents to utilise to communicate to their child are:

• Visual daily schedule
• Visual monthly calendar 
• Social stories

For a child who may be non-verbal or have limited speech, we would recommend teaching them how to utilise PECS to communicate. A helpful tip is to place these PECS visuals is common spaces so that the child is able to easily access these pictures and communicate for what they need or want. For instance:

• PECS of ‘Milk’ or ‘Snack’ on the fridge
• PECS of ‘Toilet’ or ‘Open’ next to the toilet door
• PECS of ‘Playground’ or ‘Car’ next to the entrance of the house

Parents could also place visuals of household rules around different rooms or corners of the house, to remind children about the expected behaviours at home. Some basic household rules that can be implemented are: Talking nicely, Nice Hands, Feet on Floor, etc.

Teaching Cooperation At Home

As professionals in the field of autism, we frequently hear from families that the child with autism would listen and cooperate better with their therapist/teacher, but may not do so with parents/caregivers at home. In order for parents or caregivers of children with autism to teach cooperation at home, the following strategies are recommended:

1. Foreshadowing transitions, change of activity or end of activity. This can be achieved by counting down the minutes/seconds (e.g. “TV is almost finished, in 10, 9, 8.. 3, 2, 1. TV is Finished”).
2. Following through with instructions. When the child does not cooperate or listen to the instruction the first time, parents/caregivers should repeat the instruction and be ready to follow through on the instruction with the child. (e.g. If mummy instructed child to clean up his toys but he did not listen, mummy would repeat the instruction to the child and prompt the child to clean up instead of letting the child go.)
3. First Then. Parents/caregivers could utilise this strategy to set the expectation with the child to first complete an activity before doing the second activity (which should be more preferred than the first activity). (e.g. “First shower, then you can watch TV”). 
4. Following a schedule. By utilising a visual schedule and following the schedule consistently, it helps give children with autism predictability of upcoming events/activities and clear expectations, which helps them better cooperate with the flow.

In addition to the above strategies, some children with autism may need more intensive and individualised programmes to help them build tolerance to different stimuli to cooperate better at home. For instance, they may need to learn how to build tolerance towards brushing teeth, cutting hair/nails, sounds, new food, guests coming to visit, etc. 

SUMMARY

In summary, children with autism have the ability to learn, and because autism is a spectrum, they will learn at different rates. The current gold standard treatment for autism is the Applied Behavioural Analysis (ABA) approach – break complex skills down to its component parts, pair skills with positive reinforcement, and provide sufficient practice to establish new skills.

To support individuals with autism at home, the following key strategies can be applied by parents and caregivers in the home:

1. Setting up the home to be successful
2. Establishing a structure at home and teaching the child to play independently
3. Teaching the child how to communicate functionally
4. Teaching the child to cooperate/comply

Highlights From The ‘Autism At Home’ Workshop

You can also check out the highlight video below to find out what happened during the recent Public Workshop!

We will be having our next EAP Public Workshop coming up on the 20th of March 2020. This upcoming workshop will be presented by Jochebed Isaacs, on the topic of ‘Core Foundational Skills For Autism’. You can register from now until the 31st of December 2019 to enjoy the Super Early Bird rate! Don’t miss out!