Red Flags for Autism

Roxana Rabadi, PsyD, LCP

According to The Centers for Disease Control and Prevention (CDC), “Autism is four to five times more common among boys than girls and 1 in 59 American children are on the autism spectrum.” It is important to monitor your child’s developmental milestones and bring up any concerns to your child’s pediatrician.

Could your child have autism? Review the warning signs to learn more about the red flags for autism

1. Children with autism may exhibit delays in developing speech and language skills, and inability to understand meaningful nonverbal communication. There may be a problem if:
   • By 12 months, there is no babbling or “baby talk.”
   • By 16 months, your baby has not spoken a word.
   • By age 2, there have been no meaningful two-word phrases.
   • Your child is displaying jargon speech (made-up language), or is imitating what caregivers say, and repeating it over and over.
   • Your baby has poor eye contact and won’t look at you when you are feeding him or her or smiling at him or her.
   • Your baby seems unable to understand or use hand gestures, including pointing and waving.
   • Your baby does not imitate anyone else’s movement and does not seem to notice other people’s facial expressions.
   • Your baby does not seem to recognize or respond to their name being called.
2. Children with autism tend to lack social understanding and interest in interaction. They may:
   • Appear disinterested or unaware of those around them.
   • Not know how to connect with others, seek out play, or make friends, or how to establish or maintain age-appropriate relationships.
   • Not show enthusiasm/enjoyment during interactions or do not display shared enjoyment.
   • Display aggression toward others.
3. Children with autism may exhibit rigidity, inflexibility and certain types of repetitive behavior such as:
   • Insistence on following a specific routine.
   • Having difficulty accepting changes in the schedule.
   • A strong preoccupation with a particular interest.
   • Having an unusual attachment to a toy or other object.
   • Lining up or arranging items in a certain order.
   • Repeating the same actions or movements over and over again.
   • Examining objects closely or from the corner of the eye.
   • Fascination with spinning objects and his or her reflection in the mirror.
   • Rocking, hand-flapping, twirling and finger-flicking.
   • Self-directed aggression, such as head-banging.
4. Children with certain types of autism also have a sensory hypersensitivity that is shown by:
   • Resistance to touch and cuddling – your baby doesn’t reach out to be picked up.
   • Unusual reactions to light, taste, smells, textures, and sounds.
   • Hypersensitivity to loud noise.

If you recognize any of these behaviors, know that there’s no need to despair. An early diagnosis and specialized treatment can help.

If you believe your child may need care and you aren’t sure where to start, call us at 833.227.3454, email us at info@360bhmail.com, or visit our website to Request a Consultation.

How Social Skills Training Can Help Children, Teens and Young Adults with Autism

Iris Chiang, M.Ed., BCBA

Benefits of Telehealth for People with Autism

Kate Sheldon-Princi, M.Ed., BCBA

How to Know When a Child’s Repetitive Behaviors Are a Problem

Jessica Robles, M.A., BCBA

Although the list is endless, common repetitive behaviors demonstrated by kids with autism include:

• Flapping their hands
• Banging their head against the wall
• Rocking their body
• Spinning
• Pacing back and forth repeatedly

A great example of repetitive behavior in a real circumstance would be a child with autism lining up his or her toy cars or dolls, and then — instead of playing with them — claps or flaps their hands repeatedly. The behavior we see may make the person feel better, have a soothing effect or be a way of expressing their frustration.

When to Be Concerned About the Situation

Repetitive behaviors become a concern when the behavior is a distraction, competes with learning opportunities, interferes with the person’s living activities, is disruptive to others or if the behavior is dangerous. For example, if a child is more preoccupied flapping his hands than paying attention in class, the behavior is problematic. The behavior also can be dangerous to the individual or others if it’s very physical or violent. An example of this is an individual who spins excessively to the point of throwing up regularly. If any of these situations occur, an intervention is needed.

Treating Problematic Repetitive Behaviors

Every case is different. It is important to conduct an assessment that yields a custom treatment plan to address the repetitive behavior of concern, but this general approach is recommended:

• Contact a Board-Certified Behavior Analyst (BCBA) who has experience working with the type of repetitive behaviors your child is displaying.
• The BCBA will observe the behavior occurring, assess the behavior, look at patterns, identify when the child most likely to engage in the behavior, determine how the behavior impacts the child’s life, and discuss with caregivers the significance and consequences of the behavior.
• If it’s determined that the behavior requires change, the BCBA may recommend proactive strategies. These are tools and techniques that can be used to curtail the behavior or reduce its frequency. The BCBA may recommend reactive strategies that family members or other caregivers can implement when the behavior is happening.
• The BCBA also may recommend that “replacement” behaviors be taught; that is, other, alternative behaviors that the child can engage in that meet the same needs of the repetitive behavior. If possible, the BCBA will help the individual identify the underlying cause — the trigger of the problem — to try to resolve it and prevent the problematic behavior from occurring.
• Often an occupational therapist will work alongside a BCBA – as part of a multidisciplinary approach – to curtail or reduce the repetitive behavior so the individual can focus and perform everyday activities.

With appropriate intervention and support, behavioral therapy based on principles of applied behavior analysis has been very successful in reducing repetitive behaviors in people with autism and other developmental disabilities.

If you believe your child may benefit from behavioral therapy to reduce or modify problematic repetitive behaviors and you aren’t sure where to begin, contact us for a complimentary 30 minute in-person or phone. Learn more about ABA-based therapies.

How to Prepare a Child with Autism for a New Sister or Brother

April MacPherson, MA, BCBA

1. If the child is particularly sensitive to changes in the home environment, check in with your ABA team to discuss changes you should start making before the new sibling arrives. For example, a plan might be put in place to introduce a bassinette and crib into the home, and potentially move the bassinette around so the child begins to adjust to the new furnishings and a constantly changing environment. It is never too early to introduce visuals that involve all things baby to your child so they can become familiarized with what babies look like and all the baby items that will soon be in their home.
2. Some children may respond well to introducing a baby doll into the environment and treating the doll as you might a child — holding it, feeding it, pretending to change its diapers, and certainly have it sleep in the bassinette and the crib. This not only might give them a small glimpse of what to expect, but it can also increase pretend play and social skills.
3. If the child has stronger verbal skills, explain what’s coming and how you feel, so he or she begins to understand that this is a positive development. You can read stories to the child about new babies coming home from the hospital. There are some good children’s books out there, and an ABA team can create specific social stories with visuals that are personalized to the child and the family’s unique situation.
4. If the child is highly dependent on a particular caregiver such as Mom, consider having helping hands (e.g. friends, family, babysitters) develop a strong relationship and rapport with the child before the new baby arrives. This may allow the child to get more comfortable being in another person’s care, which could also increase their flexibility to new people or situations, as well as not require the primary caregivers’ full attention at all times.
5. If the child is sensitive to noise, consult with a professional about how to effectively address this concern. Environments with babies can often have noises that a sensitive child may not be accustomed to. It would be ideal for the child to be more comfortable, relaxed and familiar with the sound of baby cries before baby comes. At the very least, it would be beneficial for them to have support systems in place to allow them to tolerate such noise – like special headphones – which should be established before the arrival of baby.
6. Many children with ASD are highly sensitive to even the slightest changes in common daily routines. Taking a different route home from school or switching the order of an activity in a way that the child is not used to can possibly trigger an unwanted behavioral episode. This can be a challenging obstacle when a new baby is added to the environment, as babies are often unpredictable with their many needs. If this is concern in any household, it is important to receive professional support to ensure that a plan is put in place to gradually increase the child’s ability to adapt to unexpected or sudden changes in common routines. The goal would be to ensure the child is more flexible and adaptable to varied routines prior to baby’s arrival.
7. Children who display aggression or other unsafe behaviors should have this concern addressed sooner rather than later. This is critical and will help minimize risk of injury. An effective behavior intervention plan that is tailored to the individual can make all the difference in the world. When seeking professional help, it is important that a Board-Certified Behavior Analyst (BCBA) is there to collaborate and create the behavior plan.

Remember that every child with autism is different, and each will react differently to a new sibling. At one extreme, some children will be affected by every change in the home, be it environmental or sensory. On the other extreme, some children may seem unaware and even oblivious to the new child, especially at first.

If you think you need help preparing your child with autism for a new sibling or would like more information about ABA-based therapy and how it might help, learn more about in-home ABA services or schedule a complimentary 30-minute phone or in-person consultation.

Challenges with Children with ASD Who Are Growing Up Bilingual

By Maria Sanchez, MA, BCBA and Crystal Herrera, MA

Enhancing Sibling Relationships in Families with Kids with Autism

Alfredo Arciniega, M.A., M.S., LMFT, BCBA

Where to Start:

• One-on-one time: Spending time with your child is a great way to make sure he or she doesn’t get lost in the shuffle of the daily routine and all of the appointments. Start with a few one-on-one activities, they will add up throughout the week.
• Teach your son or daughter about autism: Depending on the age of your child, there are a variety of resources to help children understand autism, including books, support groups, movies, etc. A good starting point is to teach them the word “autism” and what it means. But don’t get caught up with limitations. Keep it short and simple.
• Acknowledge his/her feelings: There has probably been a time when you felt frustrated or embarrassed about a meltdown. Your child may sometimes feel this same kind of frustration or embarrassment. Make it okay for your child to express his/her feelings about all of the ups and down they have with their brother or sister – without the worries of consequences.
• Use positive praise: Don’t forget to praise and give your child attention . . . frequently. Start with the small victories and work your way up. If it doesn’t come easily, try using statements like “I like how you…”, “great job with…” or “it makes me so happy when you…”.
• Have reasonable expectations: Are you perfect? None of us are. Be okay with things not always going according to plan. Kids are going to be kids, they are going to make mistakes, they’re going to misbehave. It’s is all part of the learning process.
• Encourage family activities: Find moments throughout the week to schedule activities that are fun and safe for everyone. Promoting these activities can strengthen relationships with the entire family.
• Support Groups: Sometimes it is comforting to know you aren’t alone or the only one with unique concerns. A sibling support group offers the opportunities for brothers and sisters with a loved one with autism to learn that there are other children they can share and connect with who “get it.” Find out where in your community you can connect.

If you think you need help with a child with autism or his / her sibling or siblings, learn more about in-home ABA services or schedule a complementary 30-minute in-person or phone consultation.

Toilet Training Your Child with Autism: Seven Tips for Parents

Shana Williams, MA, BCBA

Getting Comfortable: The Initial Sessions of Home-Based Behavioral Treatment

Tasha Enriquez, MA, BCBA

Starting home-based behavioral treatment may feel a little intimidating. You may be wondering what it will be like or what to expect as treatment begins. Sessions are scheduled based on the number of hours recommended in the treatment plan, as well as family preference and availability. Your clinical team will guide you every step of the way and will work with you and your family to help you adjust to the new expectations of ABA services.

The initial sessions will focus on building “rapport” between the individual receiving the services and the interventionist. Rapport refers to cultivating a relationship based on trust and on developing a connection with the client and family. It’s about establishing a comfort level and simply getting to know each other.

Building rapport is critical to set up the treatment for success, as it establishes an environment where the interventionist is paired with “fun” and “access” to preferred items and activities rather than on requests or “demands” to complete specific behavior-modifying tasks. The amount of time it takes to build rapport varies depending on the situation, the individuals involved and other factors including the number of sessions conducted each week.

The Steps to Building Rapport

How does the interventionist work to build rapport? It happens in a very purposeful way:

• First, ABA services are often initiated in the home because it’s the most familiar place and the most comfortable environment for the individual receiving services. Depending on the goal of the services, sessions may occur in other settings such as in a clinic, in the community or at school.
• Second, the interventionist works to get to know the individual slowly, recognizing there may be some fear or anxiety about having someone new or unknown in the family environment. Initially the interventionist may appear to be just hanging out in the same room as the client or watching the client engage in activities – such as general play, watching TV, or engaging with cell phone games – from across the room.During the first few sessions, the interventionist seeks to determine the client’s preferred items (his or her “stuff”) — be it toys, games, entertainment or other objects — and preferred activities, such as drawing or building things. A lot of observation occurs during this phase.Direct interactions with the client increase gradually. For example, the interventionist may start by watching the client play with their cars from 10 feet away, perhaps while sitting on the couch. Then they may move closer, say three to five feet away, and make comments or car sounds such as “VROOMMMM, BEEP BEEP, Crash them together!” to engage the client. Next, the interventionist might ask if they can play with a car, too. Each step is carefully navigated based on the client’s response to the prior step, with the interventionist making adjustments as needed to accommodate the client.
• Third, parents or other caregivers are always around during the sessions, either present and participating or acting as observers.The interventionist may request that a caregiver or other family members be involved in activities during session. If the client loves to play bubbles with dad, as an example, the interventionist will “pair” with dad and bubbles. If the client likes to go outside to race his brother on a slide in the backyard, the interventionist will join this activity. The interventionist also will ask about activities and interactions the client doesn’t like, so these can be known and avoided, at least initially, and about boundaries, including off-limit areas or activities at home.

After rapport has been established, there usually is a sense of trust and fun between the interventionist and the client. This means there’s a greater likelihood that as client goals are introduced, the client will want to participate and work together with the interventionist to achieve the goals of treatment, even when challenging. Over time, many clients come to view their interventionist as a coach — a helpful authority figure — and look forward to the sessions.

To learn more about our ABA-based services or how they may help someone in your family, please visit Applied Behavior Analysis (ABA). Or visit our Request a Consultation page to schedule a complimentary 30-minute phone or in-person consultation.

An Introduction to ADHD – Attention-Deficit / Hyperactivity Disorder

Lindsay L. Wray, Psy.D.

It is also important to note that most children grow out of ADHD, but for some, the symptoms can continue into adulthood. The behaviors that mark the disorder — namely having a limited attention span (inattentiveness) and / or being unusually active or impulsive (hyperactivity) — can occur in very young children, though in most cases the signs and symptoms become apparent when children reach school age.

ADHD is not a developmental disorder like autism but is a brain disorder influenced by a variety of factors including genetics, exposure to toxins during pregnancy and low birth weight. Medication is often appropriate to treat ADHD but is not always the only option available to treat the disorder. Behavioral therapy – with or without medication – may be helpful in eliminating symptoms that are significantly interfering with a child’s daily life functions and ability to adapt to different situations.

With behavioral therapy, which is based on principles of applied behavior analysis or ABA, a child can be taught new or different behaviors to replace problematic ones. Part of the appeal of behavioral therapy is that the benefits of modified, learned behavior can continue into adulthood, so the child is not just experiencing a better childhood, but is learning behaviors and skills that can last for a lifetime.

There are three types of ADHD:

• Predominantly Inattentive Presentation. Common signs and symptoms include frequent daydreaming, lack of focus or poor concentration, making careless mistakes in schoolwork, not listening when spoken to directly, or being easily distracted or forgetful.
• Predominantly Hyperactive Presentation. Common signs and symptoms include impulsive behavior, moving constantly with an intention to distract others, inability to stay seated when sitting still is expected, talking excessively when quiet is preferred, lack of patience and interrupting others.
• Combined Presentation. Common signs and symptoms include a mix of the above. For example, one minute the child is daydreaming and cannot focus and the next minute the child is getting up and out of his or her seat.

All children have moments of inattentiveness and hyperactivity. It is only a problem when the symptoms impair every day functions, with the child having difficulty regulating and shifting behaviors to perform basic and necessary daily activities.

If you have observed inattentiveness and hyperactivity in your child that seems to be excessive, it is worth exploring further to determine if ADHD may be the underlying cause. Your first step is to discuss the situation and your observations with your child’s primary care physician or pediatrician, or with a psychologist or psychiatrist. These healthcare professionals may offer a referral to a specialist for an evaluation.

Evaluating a child for ADHD involves administering a battery of assessment tools used to evaluate thinking, reasoning and remembering (cognitive functions), as well as assessment tools used to evaluate functions of the nervous system (neurological functions). These tests are combined with interviews with caregivers and teachers and observation in a clinic or at school. The evaluation process, when conducted by a trained professional, is friendly and non-threatening.

Receiving a referral for an evaluation does not necessarily mean your child has ADHD. In many cases the evaluation will not indicate attention-deficit/hyperactivity disorder. But if there is a diagnosis of ADHD, a good clinician will help you identify an appropriate course of action and treatment that will help address the problem behaviors and that ensures your child is treated with care and compassion.

Learn more about our evaluation & diagnostic services or ABA-based behavioral therapy services available through 360 Behavioral Health.