Parenting Styles and Self-Regulation in Autism

The latest issue (October, 2016) of the Autism journal contains an interesting study of how parenting styles affect self-regulation skills in children with autism. The article compares  a child's temperament and ability to self-regulate with the parents' style of discipline and of interacting with their child.

In the study, 40 children with autism were matched to 40 children without autism. The initial assessment of temperament and self-regulation in the children with autism compared to their peers. Not surprisingly:

Compared to their typically developing peers, children with autism spectrum disorder showed more noncompliance and less self-regulated compliance to parental demands and prohibitions and greater temperamental difficulties across several domains.

No differences in parental disciplinary styles were found in the parents of children who were better regulated as opposed to those who were not. But there was a difference in parent-child interaction styles. Parents of children who were better self-regulated were found to offer more support to their children and to request better attention from them.

The authors concluded:

Findings highlight the importance of parental supportive presence in structuring the development of socialization in children with autism spectrum disorder.

The article is titled "Self-regulated compliance in preschoolers with autism spectrum disorder: The role of temperament and parental disciplinary style." The authors are: S. Ostfeld-Etzion, R. Feldman, Y. Hirschler-Guttenber, N. Laor and O. Golan.        

A Quick Fix to Over-Sensitivity

Today was a dentist day. Now, in spite of being over-sensitive to just about everything, I am good with going to the dentist. As a child, I had a great dentist who told me to focus on something else while he worked on my teeth. I did so and got through the procedure without too much discomfort. It was a good lesson.

But I didn't generalize on it until much later. I was in the midst of a home remodeling project and hammered my thumb instead of the nail :{  I was dramatically in pain. A friend told me I was a wuss, and that I should focus my attention on something else until the pain died down. I did it, and miracle of miracles, it worked. How did he know that and I didn't. He had played sports. I had not. Sensory kids don't.do.sports because it's noisy and you get bumped a lot. And that's the point of this post sensory kids naturally react differently to pain, bumps and sounds and they avoid activities like sports where kids get so many life lessons, including "think about something else".

If Zoey is playing in the sprinkler and gets water in her face, she can focus on it with discomfort, or she can shift her attention outward to something else, like the sprinkler itself, her chest or her hands. If Martin is standing next to an alarm that sounds for several seconds, he can bring his attention back into his body (and his hands over his ears) and in that way stay grounded.

This particular lesson is a game changer, and here's why. Our brain operates with great efficiency, always trying to guess what to be ready for. If I focus on sensory discomforts, the brain says, "That's what she wants to pay attention to", and so it prioritizes the brain's focus to discomforts. On the other hand, if I am able to ignore the discomfort, and focus on something else, discomfort loses priority. What a concept. Discomfort loses priority, and we don't attend to it. What a great lesson for our kids!

By the way the circuitry that processes priorities is in the right anterior insular cortex (rAI). It feeds priorities to the anterior cingulate cortex (ACC) which takes action: behaviors, motor and emotional reactions and cognitive redirection. ....but that's a post for another day.

Food Intolerances; Brain Inflammation

Autism Speaks Science Digest is a great source for keeping track of research findings that affect the day-to-day lives of parents of children with autism. This issue had two interesting articles I'd like to share with you. The first talks about food intolerances and behaviors. The second is about brain inflammation and autism.

You can subscribe to the digest to an email version that shows up twice a month in your mailbox.



References:

1. Food and intolerances: http://www.autismspeaks.org/blog/2014/07/18/can-food-allergies-aggravate-autism-symptoms?utm_source=email&utm_medium=text-link&utm_campaign=sciencedigest

2. Inflammation: http://www.autismspeaks.org/science/science-news/researchers-target-inflammation%E2%80%99s-role-brain-disorders?utm_source=email&utm_medium=text-link&utm_campaign=sciencedigest

Nurtured Heart Approach

When I mentioned Howard Glasser's work, The Nurtured Heart Approach during one of my seminars as an example of a program for developing positive parenting/teaching/therapy skills, someone in the back asked, ‘Is that back in style again?’

The question caught me by surprise. Things go in and out of fashion, it’s true. But this method seems to have a great deal of relevance today: 

     “Parenting skills training helps parents learn how to use a system of rewards and consequences to change a child's behavior.Parents are taught to give immediate and positive feedback for behaviors they want to encourage, and ignore or redirect behaviors they want to discourage.”

 There are other “flavors” of positive interaction programs including Love and Logic and Positive-Parenting. It is the simplicity of the Nurtured Heart Approach that draws me to it.

 Glasser’s three big lessons are:

1)      Do not feed a child’s negative impulses with attention to him when he is acting-out

       2)      Give tons of positive attention to the child at times when he is not acting out

3)      Absolutely follow through with consequences when a rule is broken rule so that there is no confusion regarding what is okay and what is not okay.

 A 6-hour internet-based training class (for CEUs) is available from Glasser that very clearly describes his philosophy and shows how his techniques can help the challenging children and adults in your life.  

2012 Journal Tidbits - Autism

Here are some study findings from the Journal of Autism and Developmental Disorders - one of my favorite journals - that struck me as worth sharing. By the way, you have until Dec. 31st (2012) to browse this journal for free on line.

 1. Is picky eating due to sensory issues or due to food rigidity?
This article suggests that some picky eating problems are due entirely to rigidity in the child's food selection patterns. Treatment in this case is motivational. A child is told they will try a certain food. They are offered a choice of reinforcers (rewards). If they eat the food, they receive the reinforcer. They are also rewarded with accolades.  If they do not eat the food, they do not get the reinforcer.

When trying a new food, the authors followed a hierarchical pattern similar to Kay Toomey’s SOS Approach method:

1. Touches the food
2. Puts food to the lips,
3. Bites the food, bites
4. Puts in mouth but does not swallow
5. Chews but does not swallow
6. Swallows reluctantly
7. Accepts food without signs of displeasure.

After18 weeks, children were spontaneously requesting the new foods they had tried. The three children in the study, Ken, Robbie and Daniel accepted 5, 9 and 8 new foods respectively at the completion of the 22 week study.

Source: Koegel, R. L., Bharoocha, A. A., Ribnick, C. B.,Ribnick, R. C., Bucio, M. O., Fredeen, R. M., et al. (2012). Using individualizedreinforcers and hierarchical exposure to increase food flexibility in childrenwith autism spectrum. J Autism Dev Disord, 1574-1581.

  
2. What causes self-injurious behaviors in autism? The seven risk factors for self-injurious behaviors are 1) poor sensory processing, 2) low cognitive skills, 3) poor language / communication skills 4) poor social function, 5) age (18 mo. - 19 yrs.), 6) rigid behaviors and 7) gender. However, these factors account for just 29% of the self-injury cases seen, with sensory being the greatest factor of these (5-7%). The authors hypothesize that chronic pain and psychosocial factors may play a large factor in the remaining 71%. Clearly, there is more work to be done.

Source: Duerden, E. G., Szatmari, P., & Roberts, S. W.(2012). Toward a better understanding of self injurious behaviors in childrenand adolescents with autism specturm disorders. J Autism Dev Disord,2515-2518.

3. Is there a relationship between anxiety and repetitive behaviors? Yes, repetitive behaviors appear to be a cause of anxiety. "It is possible that, for some individuals, interventions focused on a reduction of behaviors, promoting flexibility and reducing repetitive play may consequently reduce anxiety." See the next article for more on this.

Source: Rodgers, J., Glod, M., Connolly, B., & McConachie,H. (2012). The relationship between anxiety and repetitive behaviors in autismspectrum disorder. J Autism Dev Disord, 2404-2409.

4. Are there interventions for quieting repetitive behaviors? Yes, if the child's behavior can consistently be triggered. For example, give a child with autism six cars, he will line them up. That behavior is triggerable and can be replaced with functional behavior. How about if the behavior is not triggerable? That's a harder problem. Not only do we not have interventions, we are not doing the research to look for them.

Sources:

1.  Boyd, B. A., McDonough, S. G., Rupp, B., Khan, F.,& Bodfish, J. W. (2011). Effects of a family-implemented treatment on therepetitive behaviors of children with autism. J Autism Dev Disorders,1330-1341.
2.  Boyd, B. A., McDonough, S. G., F., & Bodfish, J.W. (2012). Evidence-based behavioral interventions for repetitive behaviors in autism.J Autism Dev Disorders, 1236-1248.

5. Do children with autism also qualify for anxiety disorder? Yes, the diagnoses overlap often in children and young people (40-45%). Specifically, in children with high functioning autism, anxiety should be treated (medicine or stress reduction techniques) as a way of supporting other methods of increasing social skills.

Source: White, S. W., & Roberson-Nay, R. (2009). Anxiety, social deficits and loneliness in youth with autism spectrum disorders. J Autism and Dev Disord, 1006-1013.

Using Ease for Behavior & Flight/Fright

Here is a way to help a child with poor self-regulation (think of a wiggly, inattentive sensory child with or without autism or of a child who is alarmed by loud noise). The type of therapy I'm describing is a lite-version of sound therapy and can be done at home or at school over a period of several weeks. The product is called EASE and is modulated music on a CD (there are a variety of CDs). It is available to parents and therapists at Vision-Audio.com.

Protocol
As a protocol, the child listens to music 2x/day for 20-30 minutes, 5-7 days per week. Separate the 2 daily sessions by 3 hours or more. The volume should be set low - that is, no higher than what is needed for the child to comfortably hear the music.

Try not to use the disks too close to bedtime as the music may be alerting. Use each disk for about 2 weeks. You can rotate the disks in and out of a long-term schedule, or do a few weeks of music and then more later as needed.
 Always do a 5-minute test before starting a program. Have the child listen to music for 5 minutes, then wait 24 hours before doing any more. If there are any emotional outbursts, mood changes, or unusual behaviors during that time, do not continue therapy unless you are well-versed in sound therapy and know your way around this.  

Do not do sound therapy if the child has a history of seizures, depression, mania, bipolar disorder, or some type of psychosis – including hearing voices.

Purchasing Equipment

Purchase Ease 1 or 2 for starters and then if it appears to be working, purchase additional disks. Ease 3 is typically used for children with attachment issues. Ease 4 has especially good 3-D auditory enhancement properties. There are many disks available.

You will want to buy good headphones. Do not use Bose - they filter out the modulated music sounds. Two good choices are Sony 7506 (about $100) and the relatively childproof Sennheiser HD 500A (about $150). Both are available from on-line sources. Get a good CD Player with random-access play. I like the Sony's that are available for about $25. Putting the player in random-access mode will help keep the music from getting boring. Make sure that Mega Bass is OFF. It is harmful to ears.

By the way, Vision-Audio also has 3-D video games which can help with auditory and visual sensory integration.  There is also a very powerful iPod app available to therapists to use with clients.

Ease App on Fox News

A quick note about the EASE listening therapy app from Vision-Audio.com.  Fox News did a segment on the product. It can be seen at:

http://www.foxnews.com/health/2012/02/05/solution-for-sensory-disorders/

Sensory Vs Behavior Approach

There is a bit of unnecessary tension between the fields of applied behavior analysis and sensory therapy. There needn't be. Both approaches have tons of research. Sometimes there is an overlap in the type of therapy one might consider for a given situation. Excellent! Both types of therapists can give a problem a "go". I am grateful to have colleagues to refer difficult cases to and am glad to help their clients, as well.

I've compiled, what I contend, are a list of truisms regarding the scope and overlap of these two types of therapies.

1. Yes, there is such a thing as sensory processing disorder. Yes, there is evidence. Do sensory interventions work? In many cases, yes. See the many, many papers written.

2. No, sensory techniques do not solve all sensory issues. Sometimes a child has developed negative habits and a behaviorist can provide the best therapy. In fact, for truly challenging problems, a behaviorist approach can be a God-send.

3. A behavior approach can be the therapy of choice for feeding problems - even those with textures and tastes. Why? Sometimes the child just needs to get past the weirdness of texture and tastes. There is a rule of 13 tastings. When a child tries a food (that they don't hate) 13 times, they acclimate to it. This is especially important for children who are at risk for failure-to-thrive due to feeding issues.

4. Using one of the BIG sensory therapies such as Therapressure™ (Wilbarger Protocol), sound therapy or a strictly followed sensory diet can change the life of a child with sensitivity (hyper-reactivity) to sensory input. These children suffer - we need to help them

5. "ABA"-based therapies have helped many children with autism to attend to lessons in a regular-education classroom. This can be a life-changer for a child.

6. Movement and other sensory-style breaks throughout the day help all children to attend better in class. This can help all children achieve higher grades.

7. New medical research is uncovering unusual issues in children with autism that affect their behavior. Treating a medical issue with sensory or aba-style therapies can be a waste of time.

That's the short list. What other things might you add?