I am becoming a big fan of video modeling for kids with behaviors. The idea is to show a child a video of himself or someone else successfully performing a behavior that he has difficulty doing. Over time, the child will start to mimic the behavior.
I see a boy who is afraid to ask his teacher for help. When he is given something that he can't figure out or feels is too difficult, he'll stare at it for a few minutes, become frustrated and then move into a meltdown. His mom told me about this while I was putting together some video footage for a lecture. I asked for and got permission to use the boy as a guinea pig for my video taping.
We set up a date, and he did a variety of videos with me: an obstacle course, IM, and headphones. Finally, it was time for the video modeling piece. I asked him if he would do some acting for me in a short film about asking for help. He said okay. This was the script: He was to sit at a table, open his book to a page and start working. Then he would decide that he needed help, raise his hand and say, "I need help". We practiced it one time and then as chance would have it, a real teacher, a friend of mine, happened to come into the room. I told the boy "What luck, we have a real teacher for our video, Ms. Smith can be the teacher while I shoot the video". To my surprise, he got up from the table and ran and hid under some pillows in the clinic. It took me a while to coax him out and then I had to promise him that Ms. Smith would hold the camera while I played the teacher. We shot the video a couple of times and got a good video.
Later, I showed it to him, then showed it to his parents. He was very proud of it.
Typically, you show a video to a child every morning for a week or so until they start mimicking their own behavior, but this one worked quickly. Without additional viewings, the boy self-advocated for himself in a difficult situation that happened soon after taping. His teacher moved desks around in the classroom and he was given a spot in which he couldn't see the chalkboard. He tried out his new desk, and instead of having a melt-down, he raised his hand and said, "I can't see the chalkboard". His seat was reassigned. Later when he got home from school, he advocated for himself with his mother, as well, something that he had not done before. A real success for him.
I certainly got lucky in my first attempt, but research shows that this is a good therapy for kids on the spectrum. I am hoping to explore video modeling in conjuction with self-management techniques in the near future to see if the combined methods help to address multiple (and more serious) behaviors.
Showing posts with label Social Skills. Show all posts
Showing posts with label Social Skills. Show all posts
Sunday, June 6, 2010
Monday, November 16, 2009
Weighing in on Asperger's
With the DSM-V powers-that-be thinking about removing the Asperger's diagnosis from the DSM next edition, it's time for all of us to weigh in our two cents. Here's mine.
The Asperger label is critical to the people who are diagnosed as such. With the label, researchers can more readily target them as a group for study and treatment. Employers see the label and understand the constraints. Therapists see the label and can get right to work on appropriate therapies.
Let's look at it. There are 3 categories of autism that make a difference to me when I treat children:
- True autism with it's social and communication issues.
- PDD-NOS - a form of high functioning autism in which children can get rid of many, many symptoms with multiple therapies to the degree that you can no longer tell that it's autism.
- Asperger's - the other form of high functioning autism with good language skills, the desire to interact with others and a lack of understanding social rules (making interaction very challenging).
The authors of the DSM complain that it is difficult to distinguish Asperger's from autism and that that is the reason that the diagnosis can be removed. I disagree. A child with Asperger's has very good language skills (and in fact can be a chatterbox). Also, he/she lacks social skills in a different way than a child with typical autism does. The child with autism does not typically care to have social interaction and is content in his/her world. The child with Asperger's desperately wants friends but is often clueless on how to get and keep them.
These are easily observed differences. I say leave Asperger's in. And by the way, the same set of arguments are going to apply to PDD-NOS. Leave it in, too.
On another day, I'll talk about the impact of sensory, modulation, ADHD and obsession/compulsion comorbidity.
The Asperger label is critical to the people who are diagnosed as such. With the label, researchers can more readily target them as a group for study and treatment. Employers see the label and understand the constraints. Therapists see the label and can get right to work on appropriate therapies.
Let's look at it. There are 3 categories of autism that make a difference to me when I treat children:
- True autism with it's social and communication issues.
- PDD-NOS - a form of high functioning autism in which children can get rid of many, many symptoms with multiple therapies to the degree that you can no longer tell that it's autism.
- Asperger's - the other form of high functioning autism with good language skills, the desire to interact with others and a lack of understanding social rules (making interaction very challenging).
The authors of the DSM complain that it is difficult to distinguish Asperger's from autism and that that is the reason that the diagnosis can be removed. I disagree. A child with Asperger's has very good language skills (and in fact can be a chatterbox). Also, he/she lacks social skills in a different way than a child with typical autism does. The child with autism does not typically care to have social interaction and is content in his/her world. The child with Asperger's desperately wants friends but is often clueless on how to get and keep them.
These are easily observed differences. I say leave Asperger's in. And by the way, the same set of arguments are going to apply to PDD-NOS. Leave it in, too.
On another day, I'll talk about the impact of sensory, modulation, ADHD and obsession/compulsion comorbidity.
Thursday, October 22, 2009
Match, Repeat and Emote
This past summer I attended a wonderful workshop by James McDonald, PhD. His latest book is Communicating Partners and it demonstrates his technique of how to increase communication skills in non-verbal or lo-verbal children. The gist of his method is to engage the child in an activity by imitating the child's sounds and gestures and then adding meaningful words and phrases about the activity itself. The example of an activity that he uses is to rock a sleeping doll in it's cradle. The outcomes that Dr. MacDonald has experienced for the past 30 years is true speech and social interaction from the child.
The clinic I work at (Building Bridges Therapy Center, in Plymouth, MI) sponsored Dr. MacDonald and encouraged our parents to take part in family sessions with him while he was in residence. One of my non-verbal clients, Jack, was part of this, and we began to see increased interaction. More than that, we saw a way "in" to a highly challenged child.
As the weeks went by, goals came and went, and we therapists sometimes forgot to use the match and repeat method. But Jack is so challenging, that I continued to make this therapy my number one form of treatment for him.
Jack will answer to his name and display joint attention for a few seconds. He can speak multiple words at a time (not necessarily sentences), but is mostly lost in his own experience. His primary interest is in stimming with his favorite object. It is possible to get Jack's attention by putting him into a Belkin suit and demanding his presence. With a great deal of pressure and persistence he can be made to work in this mode. However, he does not like it, and he screams and whines to make sure that the therapist knows this.
Right after the workshop with Dr. MacDonald, I tried to hone my skills in the new practice with Jack. He responded fairly well, but he still screamed his ear-splitting screams, making it all a lot of work. The resistance I received was so strong as to make me question continuing this approach.
Then I tried something a little different. Jack came in and went to our big, green bench swing near the mirror. I gently pushed him back and forth. He spoke some words, I repeated. We made faces, we even had an amazing eight "sentence" interchange. After that, we kept swinging, while I said words like "happy", which he repeated with a smile. This lasted 8-10 minutes, then he was done and ready to run around the clinic aimlessly like a wild guy.
I took his hand and we went to a cabinet to get a worksheet. He grabbed one of my card decks. We sat at the table, I took the deck and placed it aside, telling him it was time to work. (I don't typically take things from kids.) He protested, tried to grab it back and looked like he was going to have a meltdown. Without even thinking about it, I held him tightly, rocked him and then began to emote for him. I very calmly said what I thought he was thinking. "I want the cards. What do you think you are doing? Gimme those. Who do you think you are? Those are my cards. I am very unhappy about this." and on and on. We stayed this way for 4-5 minutes with me holding him. He squirmed and protested but did not melt.
The remainder of the session went much the same with breaks every now and then for him to play freely. At the end, he went out to his mother, protesting (but not screaming) to her. She had a favorite transition object (we had agreed on) to catch his attention. We got his shoes on and got him out the door. The transition object was a God-send. He had worked hard enough. No one wanted a meltdown at this point.
It was a very difficult session, I was going by the seat of my pants the entire way. But it felt like a success for both of Jack and I. We had conversations, shared our feelings and played. There were no meltdowns. That's a lot for a feisty, non-verbal guy who is buried inside.
(Followup one week later: Jack's mother reported that he had had a very good week with behavior. His session this week was memorable in that he was happy the entire time. No melt downs, no transition issues. Let's see if this is a fluke or it continues to hold...)
The clinic I work at (Building Bridges Therapy Center, in Plymouth, MI) sponsored Dr. MacDonald and encouraged our parents to take part in family sessions with him while he was in residence. One of my non-verbal clients, Jack, was part of this, and we began to see increased interaction. More than that, we saw a way "in" to a highly challenged child.
As the weeks went by, goals came and went, and we therapists sometimes forgot to use the match and repeat method. But Jack is so challenging, that I continued to make this therapy my number one form of treatment for him.
Jack will answer to his name and display joint attention for a few seconds. He can speak multiple words at a time (not necessarily sentences), but is mostly lost in his own experience. His primary interest is in stimming with his favorite object. It is possible to get Jack's attention by putting him into a Belkin suit and demanding his presence. With a great deal of pressure and persistence he can be made to work in this mode. However, he does not like it, and he screams and whines to make sure that the therapist knows this.
Right after the workshop with Dr. MacDonald, I tried to hone my skills in the new practice with Jack. He responded fairly well, but he still screamed his ear-splitting screams, making it all a lot of work. The resistance I received was so strong as to make me question continuing this approach.
Then I tried something a little different. Jack came in and went to our big, green bench swing near the mirror. I gently pushed him back and forth. He spoke some words, I repeated. We made faces, we even had an amazing eight "sentence" interchange. After that, we kept swinging, while I said words like "happy", which he repeated with a smile. This lasted 8-10 minutes, then he was done and ready to run around the clinic aimlessly like a wild guy.
I took his hand and we went to a cabinet to get a worksheet. He grabbed one of my card decks. We sat at the table, I took the deck and placed it aside, telling him it was time to work. (I don't typically take things from kids.) He protested, tried to grab it back and looked like he was going to have a meltdown. Without even thinking about it, I held him tightly, rocked him and then began to emote for him. I very calmly said what I thought he was thinking. "I want the cards. What do you think you are doing? Gimme those. Who do you think you are? Those are my cards. I am very unhappy about this." and on and on. We stayed this way for 4-5 minutes with me holding him. He squirmed and protested but did not melt.
The remainder of the session went much the same with breaks every now and then for him to play freely. At the end, he went out to his mother, protesting (but not screaming) to her. She had a favorite transition object (we had agreed on) to catch his attention. We got his shoes on and got him out the door. The transition object was a God-send. He had worked hard enough. No one wanted a meltdown at this point.
It was a very difficult session, I was going by the seat of my pants the entire way. But it felt like a success for both of Jack and I. We had conversations, shared our feelings and played. There were no meltdowns. That's a lot for a feisty, non-verbal guy who is buried inside.
(Followup one week later: Jack's mother reported that he had had a very good week with behavior. His session this week was memorable in that he was happy the entire time. No melt downs, no transition issues. Let's see if this is a fluke or it continues to hold...)
Thursday, November 20, 2008
Abuse, Developmental Delay & IM
Here's my 3rd post today. I've been so busy with my new business, I'm behind in posting. This story is about yet another of my 11-12 year old friends. This boy was finally given the autism label just so that he could get school-based services. But in fact ... read on.
Keith
Keith is an 11 year old boy with developmental delays of uncertain origin. He was raised until the age of 4 in a home with alcohol and drug abuse as well as domestic violence. Keith’s head shows scars from serious head injuries from his early years. He was eventually removed from his birth home and provided a safe, loving home with relatives who became his legal parents. Once in school, Keith struggled in regular education classes. School Testing at the age of 9 years 6 months had shown that he was 2-4 years behind on visual motor, visual perception and motor coordination skills (Beery-Buktenica Test of Visual Motor Integration). He was provided extra help by a classroom aide, but did not qualify for supplemental services such as occupational therapy.
Assessment
When Keith walked in the door for his OT evaluation at age 11, he had the look of a puppy who has been mistreated. He walked slowly, with slouched shoulders and shuffled gait. When he spoke, his words were barely audible. Dried blood on his very short fingernails showed that he had the habit of biting his nails down into the skin. He demonstrated a poor pincer grasp, weak grip and poor strength. He was unable to lift a plastic chair to move it closer to the table. Keith’s mother said that he was unable to don shoes or socks or dress himself, and showed little initiative for play or social interactions.
When asked to jump on the trampoline, he sat in the middle and mumbled, “I can’t”. He was encouraged to try, and jumped 1” high, 10 times. Clinical observations showed that he had poor tone overall, poor strength, good reflexes, and poor coordination. An informal handwriting test showed poorly formed poorly spaced letters. The Sensory Profile indicated a definite difference from peers in the areas of auditory and vestibular processing.
Intervention
Keith’s first sessions were child-directed and sensory-based as a way of providing motivation. Within 2-3 sessions, Interactive Metronome (IM) was introduced. He was unable to identify a beat, and so hand-over-hand and patty cake methods were used exclusively for 4-6 sessions, and as-needed, thereafter. Keith was allowed to sit on a therapy ball. Although he bounced on the ball while clapping, making the task harder, it provided him with stimulation and he was better able to attend to the rhythms. Keith received IM 1-2 times per week for approximately 3 months mixed-in with sensory integration (primarily vestibular and proprioception) and ADL interventions.
Progress
Keith’s progress was dramatic. Within a few weeks, his mother told me, “The boy who came in here for the evaluation 2 months ago no longer exists.” Her son now begged her to go to the park to play. He attempted social interactions. He was attempting to dress, bathe and groom himself. During the fourth month of therapy, IM was still incorporated into therapy. Keith performed 200-500 repetitions prior to ADL and handwriting interventions to increase motivation for those tasks. He made tremendous progress with initiative, ADLs, sensory processing, social skills and confidence. Keith developed a good pincer grasp and was able to fully dress himself including buttoning a dress shirt. He still had difficulty with tying shoes. He had made very good progress in bathing and grooming, in that he could perform the tasks, but sometimes did an incomplete job. Keith’s sensory motor skills were noticeably improved. He gained an intuitive sense of what his body seemed to need and requested suitable activities both in the gym and at home. Often, those activities included vestibular and proprioceptive components and so he was learning to satisfy his sensory input needs, as well. The activity and play made him stronger, and his grip improved so that he could help move equipment in the gym. His confidence improved to the degree that he was able to initiate social interaction with other children in the clinic, and he relished playing with them.
Keith
Keith is an 11 year old boy with developmental delays of uncertain origin. He was raised until the age of 4 in a home with alcohol and drug abuse as well as domestic violence. Keith’s head shows scars from serious head injuries from his early years. He was eventually removed from his birth home and provided a safe, loving home with relatives who became his legal parents. Once in school, Keith struggled in regular education classes. School Testing at the age of 9 years 6 months had shown that he was 2-4 years behind on visual motor, visual perception and motor coordination skills (Beery-Buktenica Test of Visual Motor Integration). He was provided extra help by a classroom aide, but did not qualify for supplemental services such as occupational therapy.
Assessment
When Keith walked in the door for his OT evaluation at age 11, he had the look of a puppy who has been mistreated. He walked slowly, with slouched shoulders and shuffled gait. When he spoke, his words were barely audible. Dried blood on his very short fingernails showed that he had the habit of biting his nails down into the skin. He demonstrated a poor pincer grasp, weak grip and poor strength. He was unable to lift a plastic chair to move it closer to the table. Keith’s mother said that he was unable to don shoes or socks or dress himself, and showed little initiative for play or social interactions.
When asked to jump on the trampoline, he sat in the middle and mumbled, “I can’t”. He was encouraged to try, and jumped 1” high, 10 times. Clinical observations showed that he had poor tone overall, poor strength, good reflexes, and poor coordination. An informal handwriting test showed poorly formed poorly spaced letters. The Sensory Profile indicated a definite difference from peers in the areas of auditory and vestibular processing.
Intervention
Keith’s first sessions were child-directed and sensory-based as a way of providing motivation. Within 2-3 sessions, Interactive Metronome (IM) was introduced. He was unable to identify a beat, and so hand-over-hand and patty cake methods were used exclusively for 4-6 sessions, and as-needed, thereafter. Keith was allowed to sit on a therapy ball. Although he bounced on the ball while clapping, making the task harder, it provided him with stimulation and he was better able to attend to the rhythms. Keith received IM 1-2 times per week for approximately 3 months mixed-in with sensory integration (primarily vestibular and proprioception) and ADL interventions.
Progress
Keith’s progress was dramatic. Within a few weeks, his mother told me, “The boy who came in here for the evaluation 2 months ago no longer exists.” Her son now begged her to go to the park to play. He attempted social interactions. He was attempting to dress, bathe and groom himself. During the fourth month of therapy, IM was still incorporated into therapy. Keith performed 200-500 repetitions prior to ADL and handwriting interventions to increase motivation for those tasks. He made tremendous progress with initiative, ADLs, sensory processing, social skills and confidence. Keith developed a good pincer grasp and was able to fully dress himself including buttoning a dress shirt. He still had difficulty with tying shoes. He had made very good progress in bathing and grooming, in that he could perform the tasks, but sometimes did an incomplete job. Keith’s sensory motor skills were noticeably improved. He gained an intuitive sense of what his body seemed to need and requested suitable activities both in the gym and at home. Often, those activities included vestibular and proprioceptive components and so he was learning to satisfy his sensory input needs, as well. The activity and play made him stronger, and his grip improved so that he could help move equipment in the gym. His confidence improved to the degree that he was able to initiate social interaction with other children in the clinic, and he relished playing with them.
Saturday, October 4, 2008
Another Blog
I am starting up and new blog and that will slow my activities on this blog. The new blog will cover some of the same territory, but be focused on new interventions, technologies and clients aged 12 - 99. The new blog is called Brain Tune-Ups - that's the name of my Ann Arbor clinic. The blog is at http://braintuneups.blogspot.com/
A big factor for the change is that a small flood destroyed all of my research articles on peds and autism. But the change would have come in any event, since I am shifting my practice into teens and adults away from children. The title of this blog just doesn't do justice to where my practice is heading. I will continue to work with clients whose main concerns are self regulation or the symptoms of autism and so I will continue to have material for this blog.
On the Brain Tune-Ups site, I will continue to write about Interactive Metronome, Therapeutic Listening, Samonas, stress reduction, etc. And I'll publish the results of the adult study there.
By the way, my clinic's website is http://www.braintune-ups.com/
A big factor for the change is that a small flood destroyed all of my research articles on peds and autism. But the change would have come in any event, since I am shifting my practice into teens and adults away from children. The title of this blog just doesn't do justice to where my practice is heading. I will continue to work with clients whose main concerns are self regulation or the symptoms of autism and so I will continue to have material for this blog.
On the Brain Tune-Ups site, I will continue to write about Interactive Metronome, Therapeutic Listening, Samonas, stress reduction, etc. And I'll publish the results of the adult study there.
By the way, my clinic's website is http://www.braintune-ups.com/
Wednesday, July 23, 2008
Summer Combos
The summer goes by so quickly as I see kids individually and in groups. The groups at our clinic are called summer combos. There is (in order) 1 part music therapy, 1 part OT and 1 part speech. My aide and I run a group of five 5-7 year olds. They are delightful, but quite a handful. One of the boys has ADHD, another has a sensory modulation disorder. When one "goes off", the other follows. (During the first session, the aide and I learned this the hard way!)
After 6 sessions, we are finally able to run a structured obstacle course in our open gym without both boys making their own agenda. But we worked hard to get them modulated in our environment. I think that our successful formula during the first 5 sessions was this: for the first 1/2 hour, we gave them free play - but with limited options. For example, 3 on a bench swing, 2 in the ball pit, then switch. This let them blow off a lot of steam, but in a semi-controlled manner as they rev-up in the ball pit and then cool-down on the swing. The next 1/2 hour was spent at a table top activity, and so was quite structured. At the end of the hour, they were able to march off to speech (and snack) and sit (relatively) quietly for another hour.
I can't say that combos are my favorite part of the day - I am completely worn out, but I am very glad for these children to have the opportunity to work through modulation issues under adverse conditions.
After 6 sessions, we are finally able to run a structured obstacle course in our open gym without both boys making their own agenda. But we worked hard to get them modulated in our environment. I think that our successful formula during the first 5 sessions was this: for the first 1/2 hour, we gave them free play - but with limited options. For example, 3 on a bench swing, 2 in the ball pit, then switch. This let them blow off a lot of steam, but in a semi-controlled manner as they rev-up in the ball pit and then cool-down on the swing. The next 1/2 hour was spent at a table top activity, and so was quite structured. At the end of the hour, they were able to march off to speech (and snack) and sit (relatively) quietly for another hour.
I can't say that combos are my favorite part of the day - I am completely worn out, but I am very glad for these children to have the opportunity to work through modulation issues under adverse conditions.
Friday, November 30, 2007
Response Patterns
Here are more blocks in the foundation of self regulation. Today I am reviewing and commenting on 3 interesting pieces of research that describe response patterns in children with autism and "typical" children. The articles cover 3 different areas: sensory input, affect and joint attention (a social skill).
Article 1: Response to Tactile & Vestibular Patterns
Bar-Shalita, T., Goldstand, S., Hahn-Markowitz, J., & Parush, S. (2005). Typical children’s responsivity patterns of the tactile and vestibular systems. American Journal of Occupational Therapy, 59, 148-156.
Summary
The article describes typical 3-4 year old responses to tactile and vestibular input. There was no noted differences in gender response. There was no significant difference in responses from age 3 to age 4. Children in this study showed no sensory modulation issues. That is, they were not seekers of this input and did not appear to be hypo-reactive and/or hyper-reactive in response to the input.
Comments
The study was performed in Israel, and so is valid for that population, but in fact supports data collected from U.S. researchers including Dunn, Ayers, Blanche and others.
The article is noteworthy for the excellent review of past and current literature in the areas of sensory modulation, tactile defensiveness, and hypo- and hyper-reactivity to movement.
Article 2: Response to Mood
Begeer, S, Meerum, T. Rieffe, C., Stegge, H., & Koot, H. M. (2007). Do children with autism acknowledge the influence of mood on behaviour? Autism, 11, 503-521.
Abstract
"We tested whether children with and without high-functioning autism spectrum disorders (HFASD) differ in their understanding of the influence of mood states on behaviour. A total of 122 children with HFASD or typical development were asked to predict and explain the behaviour of story characters during hypothetical social interactions. HFASD and typically developing children predicted at equal rates that mood states likely result in similar valenced behaviour. `Explicit' descriptions were used to explain predictions more often by children with HFASD than by typically developing children. However, `implicit' and `irrelevant' descriptions elicited fewer mood references among HFASD children. Furthermore, they less often referred to the uncertainty of the influence of mood on behaviour, and less often used mood-related explanations, in particular when they had to rely on implicit information. This may indicate a rote- rather than self-generated understanding of emotions in children with HFASD. "
Article 3: Response to Novel Input on Joint Attention Skills
Gulsrud, A.C., Kasari, C., Freeman, S., & Paparella, T. (2007). Children with autism’s response to novel stimuli while participating in interventions targeting joint attention or symbolic play skills. Autism 11, 535-546.
Abstract:
"Thirty-five children diagnosed with autism were randomly assigned to either a joint attention or a symbolic play intervention. During the 5—8 week treatment, three novel probes were administered to determine mastery of joint attention skills. The probes consisted of auditory and visual stimuli, such as a loud spider crawling or a musical ball bouncing. The current study examined affect, gaze, joint attention behaviors, and verbalizations at three different time points of intervention. Results revealed that children randomized to the joint attention group were more likely to acknowledge the probe and engage in shared interactions between intervener and probe upon termination of intervention. Additionally, the joint attention group improved in the proportion of time spent sharing coordinated joint looks between intervener and probe. These results suggest that generalization of joint attention skills to a novel probe did occur for the group targeting joint attention and provides further evidence of the effectiveness of the joint attention intervention."
Other Points Made
The authors conclude that the intervention worked for these reasons:
1. It violated the established routine for the child's session.
2. The focus of the session was already on engagement with other people, and so the child was not required to do something new (beyond engaging).
3. Children in the joint attention group were becoming more adept at shifting their attention and responding with flexibility to the environment, so the surprise intervention was simply an increase in the level of challenge.
Although there was an increase in initiation and duration of joint attention there was no significant change in the child's affect, non-verbal gestures and verbalizations.
The authors note that "sustained engagement in joint attention states has been linked to language development in typical children...may be important for the language development of children with autism."
Here is a working definition for sensory modulation.
My Comments
This is a very important finding that can be applied to SI interventions in that we can add a joint attention component to activities such as a swing or a trampoline, and add a surprise element into the mix. The authors treated for 30 minutes and interjected the random stimulus during the last 2 minutes - timelines that could easily work in a typical OT session.
A question worth asking is "If the children were engaged in an intervention aimed at increasing affect, would there have been a significant change in that area (and not in joint attention)?
Article 1: Response to Tactile & Vestibular Patterns
Bar-Shalita, T., Goldstand, S., Hahn-Markowitz, J., & Parush, S. (2005). Typical children’s responsivity patterns of the tactile and vestibular systems. American Journal of Occupational Therapy, 59, 148-156.
Summary
The article describes typical 3-4 year old responses to tactile and vestibular input. There was no noted differences in gender response. There was no significant difference in responses from age 3 to age 4. Children in this study showed no sensory modulation issues. That is, they were not seekers of this input and did not appear to be hypo-reactive and/or hyper-reactive in response to the input.
Comments
The study was performed in Israel, and so is valid for that population, but in fact supports data collected from U.S. researchers including Dunn, Ayers, Blanche and others.
The article is noteworthy for the excellent review of past and current literature in the areas of sensory modulation, tactile defensiveness, and hypo- and hyper-reactivity to movement.
Article 2: Response to Mood
Begeer, S, Meerum, T. Rieffe, C., Stegge, H., & Koot, H. M. (2007). Do children with autism acknowledge the influence of mood on behaviour? Autism, 11, 503-521.
Abstract
"We tested whether children with and without high-functioning autism spectrum disorders (HFASD) differ in their understanding of the influence of mood states on behaviour. A total of 122 children with HFASD or typical development were asked to predict and explain the behaviour of story characters during hypothetical social interactions. HFASD and typically developing children predicted at equal rates that mood states likely result in similar valenced behaviour. `Explicit' descriptions were used to explain predictions more often by children with HFASD than by typically developing children. However, `implicit' and `irrelevant' descriptions elicited fewer mood references among HFASD children. Furthermore, they less often referred to the uncertainty of the influence of mood on behaviour, and less often used mood-related explanations, in particular when they had to rely on implicit information. This may indicate a rote- rather than self-generated understanding of emotions in children with HFASD. "
Article 3: Response to Novel Input on Joint Attention Skills
Gulsrud, A.C., Kasari, C., Freeman, S., & Paparella, T. (2007). Children with autism’s response to novel stimuli while participating in interventions targeting joint attention or symbolic play skills. Autism 11, 535-546.
Abstract:
"Thirty-five children diagnosed with autism were randomly assigned to either a joint attention or a symbolic play intervention. During the 5—8 week treatment, three novel probes were administered to determine mastery of joint attention skills. The probes consisted of auditory and visual stimuli, such as a loud spider crawling or a musical ball bouncing. The current study examined affect, gaze, joint attention behaviors, and verbalizations at three different time points of intervention. Results revealed that children randomized to the joint attention group were more likely to acknowledge the probe and engage in shared interactions between intervener and probe upon termination of intervention. Additionally, the joint attention group improved in the proportion of time spent sharing coordinated joint looks between intervener and probe. These results suggest that generalization of joint attention skills to a novel probe did occur for the group targeting joint attention and provides further evidence of the effectiveness of the joint attention intervention."
Other Points Made
The authors conclude that the intervention worked for these reasons:
1. It violated the established routine for the child's session.
2. The focus of the session was already on engagement with other people, and so the child was not required to do something new (beyond engaging).
3. Children in the joint attention group were becoming more adept at shifting their attention and responding with flexibility to the environment, so the surprise intervention was simply an increase in the level of challenge.
Although there was an increase in initiation and duration of joint attention there was no significant change in the child's affect, non-verbal gestures and verbalizations.
The authors note that "sustained engagement in joint attention states has been linked to language development in typical children...
Here is a working definition for sensory modulation.
My Comments
This is a very important finding that can be applied to SI interventions in that we can add a joint attention component to activities such as a swing or a trampoline, and add a surprise element into the mix. The authors treated for 30 minutes and interjected the random stimulus during the last 2 minutes - timelines that could easily work in a typical OT session.
A question worth asking is "If the children were engaged in an intervention aimed at increasing affect, would there have been a significant change in that area (and not in joint attention)?
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