Enjoying Christmas... even with food allergies

One of the memories associated with the excitement of Christmas in my childhood was the food. Special food that we wouldn't get all year round.

Savoury snacks like frankfurts dipped in tomato sauce. A whole bunch of meats and salads, or a baked dinner. Lollies. Soft drink. Cakes. Chocolates. All varieties of deserts.

So when I was diagnosed with a chronic health condition that meant refined sugar, yeast, dairy, and more recently gluten needed to be eliminated from my diet. Christmas was somehow not quite the same. Being excluded from sharing the communal meal, or enjoying the annual indulgence of certain treats, can be a very isolating experience. And if special dietary needs are not considered, it can also make you feel a little ignored...

But, thankfully, over the years my family have adjusted. My mother and I have also discovered different recipes... like the sugar-free fruit cake, sugar-free carob and most recently I have been able to adapt a recipe for pumpkin pie, using the juice from boiled dates to sweeten it.


Children with special needs and Christmas treats...

Children with special needs may have special dietary needs, physical issues or sensory sensitivities that may interfere with there ability to join in the Christmas feasting. If we want our Christmas Day to be truly inclusive, we need to make sure we find out if this is the case and what we can do about it.


Special dietary needs

Some children with Autism or Aspergers benefit from or require a gluten-free diet due to their digestive tract issues. The wrong foods can influence mood as well as cause stomach aches, constipation or diarrhoea.

The behaviour of some children with ADHD can be influenced by the amount of sugar and/or preservatives that they consume.

These are only some of the more common issues children with diverse needs and their families might face at the Christmas meal. Some things we can do is ensure that we have a number of gluten, dairy and sugar-free options that look and taste appetising available on Christmas day.

This, importantly, should include sugar-free and additive-free drinks. Carefully reading labels on fruit juice bottles is important as many brands add sugar and preservatives. Another treat is to freeze fruit juice as ice blocks. I found Nudie Crushies best for this as they are thicker and more like the smooth consistency of ice cream when frozen.

If you need recipes, the Gluten-free Goddess has some great suggestions.

My most favourite, well-stained cook book is called "Cooking Without" by Babara Cousins.

Alternately, I have found some good snacks in the Naytura food isle in Woolworths... Orgran being a great brand for gluten-free products.


Physical considerations

For some children with disabilities there are other physical factors that you will need to consider.

First, some children may not be able to successfully manipulate a knife and fork due to fine motor difficulties. One of the ways to deal with this is to have a range of easily manipulated, finger-foods available.

Other children may have difficulties with chewing or swallowing, and so having soft foods available will also be helpful.

Crushed rice+egg cups filled with salsa:
Gluten, sugar, dairy, preservative free, fun finger-food
You can fill the rice cups with anything you (or your child) like

Sensory sensitivities and preferences

We also need to take into consideration the sensory sensitivities and set preferences of children with diverse needs.

For some children, certain textures, aromas or colours will trigger a gag reflex or a meltdown.

Other children will have very specific food preferences... and will struggle to eat anything outside these preferences.

It is important not to see this as a behavioural issue. That is, we need to be careful not to think of a child with Autism who is having a melt-down because something green was put on their plate as being "naughty". Understand their specific needs and "go with the flow"...


This is just scratching the surface, I know.... so if anyone else has advice, or recipe suggestions, please share...


.

Read more...

As we head into Christmas

The count-down to Christmas has begun.
All the lights are starting to be hung.
Everywhere gatherings are beginning.
So here's some things to get you thinking...

Present-giving is such a huge part of Christmas. I remember vividly the excitement that caused sleeplessness on Christmas Eve - then the joy of finding the present at the end of the bed in the morning... Much torn wrapping later, and the day was full of new toys, food and fun.

But present-giving can also cause tension. Trying to please everyone, trying to display pleasure at inappropriate gifts, arguments over money spent, offence at gifts returned.... we all want to avoid these things.


Gift-giving and children with disabilties

I recently listened to parents of children with disabilities discuss the difficulties of presents at Christmas-time. I thought it would be good to use this blog to help build awareness of the issues that we need to consider when giving gifts to children who have special needs.

Some things you need to consider:

• Narrow interests: One thing it is important to realise is that some children with disabilities have quite narrow interests. For example, a child with autism may only use items that have Thomas the Tank engine on them.
  

• Developmental appropriateness: You need to consider the developmental appropriateness of a toy - not just its age appropriateness. For example, some children who have vision impairments use their sense of taste to continue exploring their environment long after their peers have stopped mouthing toys. This means that toys with small detachable parts that might be age appropriate will not be developmentally appropriate for the child as they could be a choking hazard. Other aspects that need to be considered are the child's intellectual, gross motor and fine motor skills. Children with disabilities such as Down Syndrome or Autism may find it more difficult to hold pencils, pick up small items and play with things that involve threading, constructing and significant muscle control in the fingers. Others may find it difficult to balance and use the gross motor skills involved in riding bikes or climbing. And others may find the cognitive challenge of some games such as puzzles, board games, card games and craft activities, beyond their cognitive ability.
  

• Sensory sensitivities: Some children with disabilities are very sensitive to certain textures, sounds and even colours. Toys that do not align with their sensitivities will not be used, and may even cause them some distress.

So how can you make sure you purchase an appropriate gift?

The easiest way is to ask parents. They will be able to tell you about the child's abilities, interests and favourite toys. And don't be offended if they give you a list of specific things or places to shop for their children.


Here are two sites that were recommended by parents:

http://www.specialneedstoys.com.au/shop/

This Australian site provides a range of toys suitable for children with Autism Spectrum Disorders, Communiation and Sensory Processing Disorders, ADHD, Physical Disabilities and Cognitive and Learning Delays. They have toys priced from under $5 to over $100.

The toys include a whole range of things, from puzzles to computer-based games.

http://www.amazon.com

Another parent recommended this Amazon search entitled "Bestsellers in special needs multi-sensory toys."

Spectronicsinoz also has a range of games, though they are more expensive and generally educational. Here are some examples of their games:

Spot on Games
Card Games
Switch-friendly computer games for children with physical disabilities
More computer games called Play with me

All the best for your Christmas shopping :) ... and may your Christmas be full of fun.

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Helping struggling readers experience success

In the last post I mentioned an article by Dyck and Pemberton (2002) that provides a good discussion of the different ways you can adapt texts so that children with literacy difficulties can more successfully interact with them. In this post I want to outline some of those key strategies.

Functional Reading

When supporting children who have literacy difficulties, especially if they are older and moving into high school, we should challenge ourselves to think differently about teaching literacy. Instead of focusing primarily on teaching literacy for literacy's sake, we should focus on teaching literacy skills that will help the child or youth learn and succeed in any literacy-based task that they come across - in the classroom and outside the classroom.

This is called functional literacy (Mercer & Mercer, 2001).


Why we read

Reading is usually done for a purpose. You may read to entertain yourself, to find out information or to find out how to make something. Knowing this purpose is an important first step in reading. This means that the emotional experience of reading is usually defined by the reader's ability to achieve that purpose.

So if you sit down in a restaurant and pick up the menu for the purpose of ordering your meal, and you find you can't read it due to unfamiliar words or poor presentation, you are likely to find it a very frustrating experience - and one which you will not be in a hurry to repeat.


Choosing and adapting texts

To ensure that we don't put children or youth into the position of feeling this frustration, and doing everything they can to avoid the reading experience, we need to make sure they know why they are reading and that they can achieve this purpose. As Dyck and Pemberton (2002) suggest, when giving a student a text to read - whether it is a novel, a text book or anything else they will need to read on their own in order to succeed with a task - the first thing we should ask ourselves is whether the student can read the text with enough speed and understanding to use it. We should be aiming to ensure that they have an equal opportunity to achieve in the task they have been given.

To get a sense of whether the student will be able to read the text, you could do one of two things:

1. Circle every word you think they may find difficult. If this indicates that they cannot read the majority of the text without your help, then you need to adapt the text.
2. Get them to read a small section of the text. Again, if this indicates that they cannot read the majority of the text without your help, then you need to adapt the text.

Ways we can adapt any tasks involving reading and writing

Dyck and Pemberton (2002) discuss a range of ways we can adapt literacy tasks. These are discussed below:

1. Using alternative texts: Support groups such as SPELD NSW can help provide information and catalogues of books that are described as "high interest, low ability." These books are written with simpler language, and use age appropriate images and content especially for older primary school students.
   
2. By-passing reading: In some cases it is more important for students to be able to learn content and display their knowledge than struggling to read and/or write. For this reason, students with significant literacy difficulties are eligible for readers and scribes in formal exam situations. By-passing reading in class can be done through buddy reading, using audio books and text to speech technology which is becoming more and more freely available in schools.
3. Decreasing reading: In other cases students can achieve the purpose of a task through the reduction of reading/writing demands. For example, copying notes off the board can be one of the most demoralising and meaningless experiences for a student struggling with literacy. Instead, the student could have a fill-in-the-blank worksheet which helps them become familiar with key terms. Using mind maps, cartoon strips and a whole range of other advanced organisers can also be of great help for a student to learn rather than struggle through trying to read.
4. Supporting reading: The use of glossaries, personal dictionaries, notes in margins, colour-coding, images, diagrams and so on are great ways to help struggling readers focus on the key points of a text and achieve the purpose of an activity rather than being bogged down in decoding words on a page.
5. Organise reading: Organising the information on the page differently can help students who are struggling to read. For example, using dot points instead of lengthy paragraphs. Enlarging the font, using numbering or a flow chart to clarify a sequence, and adding any images will help the student again focus on the content of the text.
6. Guided reading: Reading a text together is a good way of helping a student focus on meaning. This can be done at home, or through small group reading in class. It could also involve choral reading, where everyone in a class reads along with the teacher.
   

References:

Dyck, N. & Pemberton, J.B. (2002). A model for making decisions about text adaptations. Intervention in School and Clinic, 38(1), pp28-35.

Mercer, C.D., Mercer, A.R. (2001). Teaching Students with Learning Problems. Ohio: Prentice Hall.

Read more...

Addressing the emotional scars left by reading failure

So how can we address "the emotional scars of frustration, shame and depression that can result from a lack of identification and appropriate support for young people" (Long, MacBlain & MacBlain, 2007, p125)?

Long et al discuss a case study where a secondary student (Matthew) with long-standing literacy difficulties was supported, both academically and emotionally, in their academic context. Here are some of the strategies that worked for him:

1. Bypass strategies: Dyck and Pemberton (2002) provide a great discussion of key strategies that ensure a student can work towards the outcomes set in the curriculum without being disadvantaged by their difficulty with literacy. Some of these strategies include presenting information in different ways (flow charts, images, video) or using supports such as readers (text to speech technology, or a peer reader). I will discuss these further in a future post.

2. Empowerment strategies: Long et al. discuss the importance of helping Matthew identify his learning style. This turned out to be visual, which is common for students with learning disabilities such as dyslexia. The next step was teaching him to independently identify and use a range of strategies, such as graphic organisers, to assist in any literacy based task.

3. Staff training: Empathy from a teacher was identified as a key element of success in addressing the emotional scars of literacy difficulties. Teachers who understand the difficulties these students face, and who are flexible in their teaching approach because of this understanding, can have a significant influence in the healing process. When training staff, it is important that ALL staff be trained in understanding literacy difficulties and conditions such as dyslexia and dysgraphia, especially in a high school context. This means that the student feels supported across subjects and years, not just on one teacher's class.

4. A whole school approach: Again, for consistency of support, Long et al. identify the importance of a whole school policy when supporting children with significant literacy difficulties. They identified that the policy included specifications that:

• The student not be asked to read aloud in class
• The student not be required to complete dictation tasks
• That to avoid copying copious notes off the board the student be expected only to copy a summary of key points or be provided with a handout in advance of the lesson.
• The student use a personal dictionary in which to record subject-specific words, to be provided to him at the beginning of each topic.
• That teachers increase the use of summaries, mind maps, diagrams and charts.
• That teachers would, wherever possible, mark Matthew's work in his presence and emphasise learning rather than marks.
• That each department would identify a "collective belief system regarding dyslexia and how each might support students... who were experiencing anxiety caused by failure."

5. Mentoring: Having a weekly, one-on-one session with a teacher mentor (not necessarily a specialist trained teacher) allowed Matthew to ask any questions he considered too embarrassing or humiliating to ask in the more public setting of the classroom. This mentor also helped him with organisation (eg. colour coding books and folders according to subjects) and time management.

6. Explicit instruction on study skills: This was made available to any student within the school.

7. Collaboration with parents: Matthew, his parents and the school worked together to set realistic goals, processes to achieve these goals and a rewards system for recognition of success. This allowed Matthew to feel successful as he made improvements, rather than always feeling like a failure because he wasn't "keeping up" or demonstrating the same skills as his peers.



References

Dyck, N. & Pemberton, J.B. (2002). A model for making decisions about text adaptations. Intervention in School and Clinic, 38(1), pp28-35.

Long, L., MacBlain, S. and MacBlain, M. (2007). Supporting Students with Dyslexia at the Secondary Level: An Emotional Model of Literacy. Journal of Adolescent & Adult Literacy, 51(2), pp. 124-134.

Read more...

Literacy difficulties, self-esteem and behaviour

Literacy difficulties can be devastating for a child's self-efficacy in the context of any activity relating to reading and writing. Because so much of our lives - study, work and general life activities - involve literacy, people who struggle in this area can be at great risk of issues such as anxiety, depression, anger and generally poor self-esteem (Ryan, 2004). This applies to children diagnosed with dyslexia, dysgraphia... or those with no diagnosis at all.


The Gap between Ability and Performance

"...students with dyslexia internalize feelings of failure as a result of their dyslexia and not as a result of their lack of effort or commitment." (Long, MacBlain & MacBlain, 2007 p181)

There is nothing more frustrating than knowing something and not being able to follow it through. This is why we value freedom so much... it means that we can fulfill our potential, that the effort we put into things leads to the results we expect.

If we want to run a marathon, and we train hard and have a good sense of our abilities as a marathon runner, then we will have reasonable expectations of ourselves. And so long as we don't get injured, we probably will live up to those expectations.

Frustration, anger and even depression can come out of repeatedly unmet expectations.


What Shapes our Expectations?

When thinking about literacy and learning, we need to think about expectations of families and teachers as well as the child themselves (Ryan, 2004). Expectations about a child's potential performance at school or in literacy tasks are shaped by many things.

A family's expectations of a child's literacy performance may come from their communication, story-telling and reasoning ability. For example, I worked with one family whose child would entertain them for hours with highly engaging, convoluted stories. The frustration for that family was that when the child was asked to write down their stories, they wrote very short passages of sometimes meaningless text.

A teacher's expectations may be shaped by what they see in class. For example, the child mentioned above was very entertaining and articulate in class. However, his lack of task completion was mainly put down to the fact that he was "the class clown" and was not motivated to concentrate on individual, written tasks.

The child's expectations were shaped by their experience. They knew there was a lot going on in their head... but they were not able to succeed when it came to written literacy tasks. This was starting to lead to thoughts that they were somehow "dumb" or "stupid" or at least very different to their peers (Lyons, 2005-2010).


The Danger of Unmet Expectations

If we look at Maslow's hierarchy of needs we recognise the significance of repeatedly unmet expectations.

Diagram Adapted from Gorman, 2010 Table 1

For a child who is unable to achieve self-esteem through recognition from teachers and/or parents, or through achievement in class, they will find it very difficult to progress to achieve their full potential. This can have a crippling effect on their life in the community and post-school. There is some evidence that literacy issues, unaddressed, can (in the worst case scenarios) even lead to such outcomes as unemployment, poverty, violence and/or imprisonment (Robinson & Dally, 2008).

Children whose literacy abilities do not match their learning abilities are also at risk of being trapped in what we call the failure cycle (Robinson & Dally, 2008). This means that as they experience progressively more failure, they are less and less likely to even make an attempt to achieve at school. This can lead to disruptive and avoidance behaviour, and possibly dropping out of school early.


Some Signs of the Emotional Impact of Literacy Difficulties

In my experience I have seen a range of behaviours that have primarily signalled a struggle with literacy. These included:

• The Class Clown: Talking, making jokes and generally benign but disruptive behaviour in class that leads to lack of completion of tasks. Much of this behaviour can be either an avoidance or delay tactic and can signal anxiety.
• The Refuser: Generally refusing to complete tasks, or using avoidance techniques such as trips to the toilet to get out of completing tasks. This can also escalate into "meltdowns" and more aggressive verbal or physical incidents if the child is pushed to complete the task.
• The Delay Technician: This child was very skilled in delaying the task so long that adults or peers would complete the task for them. For example, they would uhm-ahh and repeatedly say "I can't do it" until the "helper" took pity on them (and anyone else waiting for them to finish so the group could move on to the next task) and told them what the word was.
  

These are only some of the behaviours that should ring warning bells for us when supporting children with literacy difficulties. It is important for us not to think of the child as lazy if they are not living up to their potential. We should first examine if it is signalling anxiety, depression, anger and poor self-esteem as a result of expectations that are unreachable due to their literacy difficulties (Ryan, 2004).


Wholistic Literacy Support... Addressing the Emotional Child

The upshot of this is that, with any literacy support program, we should be factoring in the emotional and motivational side of reading (Long, MacBlain & MacBlain, 2007). Just teaching a child phonics or how to use technology will not necessarily undo all the effects of repeated failure in the past. We need to address their need for self-esteem to ensure they can reach their personal potential.


References

Gorman, D. (2010) Maslow's hierarchy and social and emotional wellbeing. Aboriginal and Islander Health Worker Journal, 33(5), pp. 27-9. Retrieved from eprints.usq.edu.au/6830/4/Gorman_AIHWJ_V34N1_2010_AV.pdf

Long, L., MacBlain, S. and MacBlain, M. (2007). Supporting Students with Dyslexia at the Secondary Level: An Emotional Model of Literacy. Journal of Adolescent & Adult Literacy, 51(2), pp. 124-134.

Lyons, A. (2005-2010). Self-Esteem and Learning Difficulties. Retrieved 12/10/2010 from www.ldail.org/esteem.cfm

Robinson, G. and Dally, K. (2005). Understanding literacy and numeracy. In P. Foreman (Ed), Inclusion in Action, pp 246-301. Thomson Learning: Victoria.

Ryan, M. (2004). Social and Emotional Problems Related to Dyslexia. Retrieved 12/10/2010 from www.ldonline.org/article/Social_and_Emotional_Problems_Related_to_Dyslexia

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Dyscalculia

Every day we are faced with mathematical problems. We need to read clocks, estimate times and do some arithmetic to make sure we are not late to appointments. We need to measure ingredients and estimate sizes. We need to do quick mental arithmetic when shopping, and read charts to make sure we don't speed.

Dyscalculia is more than being a bit slow to pick up mathematical skills. Or being a bit slow with mental arithmetic because you haven't practiced enough, or have used a calculator too much.

Dyscalculia is a life-long learning disability that effects your ability to learn and develop mathematical skills, including those basic skills used in everyday life.


What are the signs?

Some of the signs of dyscalculia as listed by SPELD and Eberly College of Arts and Sciences, 2008 include:

• Difficulty learning mathematical terms and concepts
  
• Difficulty identifying numbers, signs and symbols
  
• Difficulty with basic functions such as addition, subtraction, multiplication and division.
• Difficulty remembering number facts, times tables and formulae. This can also translate into difficulties remembering scores in sport.
  
• Difficulty writing down working or an answer to written and numerical maths problems, including reversals, difficulty lining up numbers in correct columns, confusion over directionality and an inability to translate thoughts into symbols.
  
• Difficulty reading written Maths problems.
• Difficulty with reading time and time management.
  

Why?

As for dysgraphia, dyscalculia is linked to processing difficulties. Visual processing difficulties lead to reversals and confusion over numbers and symbols. Language processing difficulties lead to struggles with the language associated with maths, which in turn effects the child's ability to learn the mathematical concepts. Sequencing difficulties effect the person's ability to follow through with the logical processes involved in Maths.


In the next posts we will look at some ways we can help children who have been diagnosed with dyscalculia and dysgraphia.


References

Eberly College of Arts and Sciences (2008). Dyscalculia. Retrieved 28/09 from www.as.wvu.edu/~scidis/dyscalcula.html

SPELD (2008). What is Dyscalculia. Retrieved 28/09 from www.dyslexia-speld.com/LearningDisabilities/WhatisDyscalculia/tabid/139/language/en-AU/Default.aspx

Read more...

Ask Amanda: Dysgraphia and Dyscalculia

Not too long ago a parent asked me to blog about Dysgraphia and Dyscalculia. They were wondering what these labels meant, and what could be done to help their child.

Dysgraphia and Dyscalculia can be diagnosed alongside Autism Spectrum Disorders and Attention Deficit Disorders. Dysgraphia and Dyscalculia are neurological disorders that effect the way people learn literacy and numeracy skills (NINDS, 2009; SPELD, 2008).


Dysgraphia

Dysgraphia is demonstrated in a person's significant difficulty with written expression - handwriting, spelling and structuring a piece of written work.

Children with dysgraphia generally have difficulty with processing and sequencing information (Eberly College of Arts and Sciences, 2008). They may also have auditory, language and visual processing difficulties as well.

Information processing difficulties mean that children find it difficult to transfer what they are thinking onto paper. This can be because they find it hard to store the information long enough in their working memory to go through the physical process of writing it letter-by-letter, word-by-word. So what is a complex, creative story in their head, may come out as a jumble of random words and/or sentences on paper.

Sequencing difficulties mean that they find it hard to use the conventions of writing, like spelling and grammar. Proficient writers are able to spell "automatically" as they remember patterns of letters and shapes of words, thus not having to really pay attention to each individual letter in a word. This frees up a lot of working memory so that they are able to write fluently and focus on making meaning rather than spelling. For children with sequencing difficulties, it means that they will struggle to make meaning because they have to focus to much on each letter.

The same goes for grammar. Proficient writers most of the time use grammatical patterns without having to actually think about it. But children with sequencing difficulties will struggle to put their ideas on paper as well as follow the conventions of writing.

For children with auditory processing difficulties, they will struggle to use sounds to help check spelling. For children with language processing difficulties, who may think in pictures or concepts rather than words, it will be very difficult to translate their ideas into writing. For children with visual processing difficulties, it would be very difficult for them to use visual cues such as the shape of letters and words.


A Sample

You can see a sample of writing from a child with dysgraphia at http://dyslexia.learninginfo.org/dysgraphia.htm


Next time... I will discuss Dyscalculia...


Links used in this blog post:

http://www.as.wvu.edu/~scidis/dysgraphia.html

http://www.dyslexia-speld.com/LearningDisabilities/WhatisDysgraphia/tabid/90/language/en-AU/Default.aspx

http://www.ninds.nih.gov/disorders/dysgraphia/dysgraphia.htm

http://dyslexia.learninginfo.org/dysgraphia.htm

Read more...

The rage and recovery stages

Following on from the previous post, the next two stages in the rage cycle include the rage stage, then the recovery stage (Myles & Southwick, 2005).


The Rage Stage

It is at this stage that you will see uncontrolled, explosive behaviour. It could be physical, such as hitting, kicking and self-injurious behaviour. It could be verbal, with screaming and yelling of abuse. It could also be withdrawal, where the child withdraws from contact and any interaction.

This is not the moment for trying to teach new skills or redirect the child.

What should you do?

Myles and Southwick (2005) suggest a range of things including:

1. Protect: The child, property and others around the child. This could include finding non-harmful ways for the child to release adrenaline such as those suggested in the previous post.
2. Plan: Have an "exit" strategy, one that allows the child to escape from the pressures of the situation without feeling humiliated or disempowered. Use this routinely, preferably having discussed it previously in a teachable moment. This should be your crisis management plan.
   
3. Prompt: With as few words as possible, and very circumspectly, prompt the child towards there safe space (as discussed in the previous post).
   
4. Prevent a power struggle: Don't argue or respond or try to negotiate. At this stage in the rage cycle the more you say, the more the behaviour is likely to escalate. In my experience, a simple and calmly repeated phrase can help diffuse a child's anger. This could be a simple prompt towards the child's safe space.
   
5. Timer: Having a timer that provides the child with a visual prompt as to when they should stop can help them find an end to the rage stage.
   

As Myles and Southwick (2005) state, it is important (and difficult!) to remember not to take the child's behaviour personally.


The Recovery Stage

As with all stages in the rage cycle, every child will act differently at the recovery stage. Some will be so exhausted that they will fall asleep. Others will use withdrawal into fantasy or denial to remove themselves from the incident. Others will be apologetic.

What should you do?

At this stage it is likely that both adult and child are feeling fragile and emotionally drained. It is important that the recovery stage is just that - used for recovery. This stage is also not the time to discuss the incident. Don't place any demands on yourself or the child until you are absolutely sure that the recovery stage is over.

You could:

1. Rest, and allow the child to sleep.
2. Redirect the child into their special area of interest.
3. Use relaxation techniques - for example: deep breathing, stretching, blowing bubbles.
4. Give the child space if they need it.
5. Use familiar structure and routine to help settle the child.

Once you have both recovered, then you will have teachable moments where you can plan, discuss and use tools like social stories to address the reason why the meltdown happened in the first place.



References

Myles, B.S. and J. Southwick (2005). Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and Meltdowns. Autism Asperger Publishing Company: Kansas

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The Rumbling Stage

When dealing with meltdowns, or rage, it is important to recognise when it is possible to negotiate, re-direct or deflect the child's emotion... and when it is time to "ride it out", letting the emotion take its course. If we can catch a child/youth before the emotion takes over their reasoning or thinking power, we are more likely to prevent or minimise the meltdown (Myles and Southwick, 2005).


The Rage Cycle

According to Myles and Southwick (2005) the rage cycle includes three main stages - the rumbling stage, the rage stage, and the recovery stage. They suggest that before and after these stages teachable moments occur. Once the rage cycle starts, the opportunity for the child to learn is gone.

At this stage it is about management and, where possible, prevention of escalation.


The Rumbling Stage

Parents have often expressed to me the fact that they can tell when a meltdown is coming on. The signs could be categorised into four different categories:

• Physical signs, including fidgeting, tapping, restlessness, muscle tenseness, grimacing
• Verbal signs, like name calling, threats, grunting, increasing or decreasing volume
  
• Behavioural signs, like refusals, crying

What can we do in this stage?

Myles and Southwick (2005) identify a range of strategies that could be used in this stage. Some ideas include:

1. Provide a safe, cool down space: Help the child feel safe by moving to a space that is familiar and away from the triggers of their meltdown.
2. Provide a physical outlet: Give the child a way to get rid of the excess adrenaline that is flowing as a result of their emotion. This can be anything from squeezing a stress ball, to bouncing on a trampoline, to tearing up paper.
3. Remain calm and quiet: Don't try to reason with them, remain calm and close-by. Walk with them if necessary. For some children, touch can also be helpful.
4. Redirect: Using a child's interest it may be possible to redirect their attention and emotion. You might need to help the child re-evaluate their goals.
   
5. Use routine: Help the child get back to familiar and safe sequences of events.

But the most important thing to remember at this stage is that, as adults, it is important that we remain calm and flexible, adapting to the needs of the child as the child will not be able to be flexible once they have entered the rage cycle.


References

Myles, B.S. and J. Southwick (2005). Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and Meltdowns. Autism Asperger Publishing Company: Kansas

Read more...

Why are they melting down?

Meltdowns are a physical, adrenaline-led response to a range of different emotions and triggers (Lipsky, 2009). These can be anything from anxiety, anger, frustration to sensory overload. An important step in dealing with meltdowns is to understand the reason why they are occurring (Myles & Southwick, 2005).


Functional Behaviour Assessment

Part of Applied Behaviour Analysis is identifying the function of behaviour. In a previous post, four key functions of behaviour were highlighted - to avoid something, get something, sensory-based responses and pain attenuation.

Functional behaviour assessments are about recording observations and analysing them to identify why repeated difficult behaviour happens. You can find out more about this in this post or by reading this document from www.usu.edu.


An online tool

http://www2.monacoassociates.com/masontheweb/index.aspx

Parents, teachers and therapists can try this easy-to-complete online tool that can give a quick indication for the possible function of a child's behaviour. You fill out a series of questions online, then you get a table which indicates which of the key functions of behaviour are most likely to be behind your child's behaviour. Below is a sample of what you will see.

Printable Resources

If you prefer a more complex, thorough process (especially if you are a teacher) you might want to download the following forms from polyxo.com:

Behaviour Observation Forms
Functional Behaviour Assessment Forms



References:

Lipsky, D. and Richards, W. (2009). Managing Meltdowns: Using the SCARED Calming Technique with Children and Adults with Autism. Jessica Kingsley Publishers.

Myles, B.S. and J. Southwick (2005). Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and Meltdowns. Autism Asperger Publishing Company: Kansas

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Ask Amanda: Managing Meltdowns

At the Autism and Aspergers Support Group Inc Hawkesbury meet in July I was asked by a parent about how to manage meltdowns. There is not simple way to answer this question, though other parents did provide some suggestions. Some things that work for other parents and their children include:

• Staying calm
• Get down to your child's level and sit with them
• Speak reassuringly, assuring them they are not "in trouble"
• Hug them tightly or wrap them tightly in a blanket (for some children with Sensory Integration issues this can be comforting)

Since that time I have been reading some information on the topic. One book that I have found particularly useful is Managing Meltdowns: Using the SCARED Calming Technique with Children and Adults with Autism. It is written by Lipsky, who has been diagnosed with high functioning autism herself, and Richards.


SCARED stands for...

Safe - find an environment, or follow the child to an environment where they feel safe.

Calm - stay calm, speak calmly, talk in literal language.

Affirmation - show that you know what they are afraid of by putting it in words.

Routine - work with repetitive, routine behaviours that they may be using to help calm themselves (so long as it does not involve self-harm).

Empathy - show you are there to support and help.

Develop an intervention strategy - make a step-by-step, concrete plan for what to do if a meltdown happens again.


This month...

This month I plan to explore these six elements of responding to meltdowns in more depth.


Reference:

Lipsky, D. and Richards, W. (2009). Managing Meltdowns: Using the SCARED Calming Technique with Children and Adults with Autism. Jessica Kingsley Publishers.

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Helping children stay on track

How do we help children who are constantly going off task? How do we help children who don't think before they act?


Reducing distractions

One of the most important ways to help children with inhibitory control difficulties stay on task is to reduce the number of things going on in the child's environment.

- When learning: In the classroom there are many possible distractors. These can include things hung on walls, peers talking, movement around the room or outside a window. One key strategy is to have a seating arrangement that means the child is sitting away from windows, facing the front with no peers between them and the teacher and no distracting wall hangings within their direct line of site. Keep ambient noise low, paying attention to the noise coming from fans, heaters and other students.

Having clear, written rules that have been negotiated with your students will also be essential to maintain a distraction-free environment and help children with inhibitory control issues stay in their seat and on-task. You will need to have a display of these rules and frequently refer to them.

- When doing homework: It is important that a child with executive functioning difficulties not be expected to complete a task requiring concentration in a room that has many distractors. Many of these children benefit from a quiet, clear space away from TVs, toys, computers and other possible distractors.


Expect concentration on only one thing at a time

Use Pointers

Reading can be a very difficult task for children who have trouble with their "inhibitory control" because it can effect their concentration. They can lose track of where they are in the text, skipping words or even whole lines. They can be distracted by noises, and find it hard to pick up where they left off.

An effective tool is a pointer. This can be anything from a child's finger, to a laser pointer on the board, or a ruler under the line they are reading. Another tool is a little window cut out of a piece of card large enough for the child to only see one or two lines of the text at a time.

Using colour-coding can also be useful. You can highlight key words by writing or highlighting them in different colours. You can write/highlight the beginning of each paragraph, sentence or line in a different colour to help children keep track.


Break it down

Big chunks of information, or lots of steps in a task, will be hard for a child to remember if they are struggling to filter out distractions. To address this we should break tasks down so they can focus on one step at a time. The best way to do this is through checklists or graphic organisers (British Columbian Ministry of Education, 2010).

You can use visual checklists on Velcro strips where a child can remove a picture and put it in a "finished" box as each step is completed. Some places where you can get free visuals include www.visualaidsforlearning.com and www.do2learn.com

You can use a written checklists for children with good literacy skills, ensuring they can check each step once it has been completed.

It could also be beneficial to have relevant rewards for each step that has been completed. For example, a child might get 1 point each time they finish a step, and once they have gathered 10 points they are able to dip into a lucky dip of small items relevant to their interest. Other children will be motivated by merit certificates, and others by time doing a favourite activity.

Here are some charts you might be able to use:

• Desk Chart
• Step-by-step Chart
• Flow Chart
• Homework checklist (for older children)
• Chain of events
  

Stop, think, do....

To help children who are struggling to think before they act the steps involved in the Stop, Think, Do program can be used. I have discussed this previously here and here.


In conclusion...

Here is a great checklist from the British Columbian Ministry of Education that can help teachers working with children who have ADHD: www.bced.gov.bc.ca/specialed/adhd/app4.htm The strategies in this document could be helpful for any child who has executive functioning difficulties.


References

British Columbian Ministry of Education (2010) Teaching Students with Attention-Deficit/Hyperactivity Disorder: Planning for Success at School. Retrieved 31st July, 2010 from www.bced.gov.bc.ca/specialed/adhd/plan.htm

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Executive functioning and self-control

The final element of executive functioning is "inhibition." This is the function that helps us control our responses to what we see, hear and feel.


The Tigger Syndrome

Anyone who is a lover of Winnie-the-Pooh by A.A.Milne will know what I am talking about. If you aren't a fan, visit the official Disney Winnie-the-Pooh and find out a little more about Tigger. For those who don't know, his hobbies include:

"Bouncing, causing mayhem, exaggerating the truth"

For those of us who are fans, we also know that Tigger isn't a "malignant" character. He never intends to cause harm. He just gets side-tracked, is over-enthusiastic (some would say out of control :)), and has a very fertile imagination.


Perhaps Tigger has executive functioning difficulties....

Perhaps he forgets to stop and think before he acts. Perhaps his "inhibitory control" is not functioning as it should.

As Oates and Grayson (2004) state,

"If you were unable to inhibit responses to stimuli that do not relate to the task that you have planned to do, then it would probably be impossible to complete it and achieve your goal. You would be drawn from one stimulus to another, in a haphazard fashion, and it would be impossible to undertake any coherently organised action."

Example: Having a conversation

A conversation with a child who has difficulty with inhibitory control may go something like this...

Hi, Billy. That's a great picture you are drawing. Can you tell me about it?

Yeah. I am drawing a truck. I saw a truck the other day. It was red. I spilt red jelly all over my mum. She told me I had to clean it up. My room has lots of cupboards. I have a nintendo......

The original goal of the conversation was lost as the child followed whatever train of thought occurred. This can happen with tasks, where a child gets distracted by sights, sounds, movement and any other irrelevant stimuli. This is quite natural for very young children, but as we grow older and develop our executive functioning skills this behaviour should disappear or at least dramatically decrease.



In the next post I will explore some ways to help children with inhibitory control issues stay on task


Reference:
Oates, J. & Grayson, A. (2004). Cognitive and Language Development in Children. Blackwell Publishing: Oxford.

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Helping children self-correct and problem-solve

How do you avoid meltdowns when something changes? How do you help your child recognise that what they are doing is making others upset? How can you help a child recognise when they have said or done something that "crosses the line"? Or when someone else has done something to them that "crosses the line"?


Prepare

You are about to go to a new shopping centre. Or your child is about to go to a new school. These situations will bring up a whole range of new information that they will need to quickly process in order to behave as expected and cope.

For children with executive functioning difficulties, as mentioned previously, this will cause many difficulties (Oates & Grayson, 2004). The best thing to do is to prepare your child as much as possible for their new environment.

Talk about what is going to happen. Talk about the environment, and set relevant rules (Dodd, 2005). Further, whilst talking use video, photos, even a drive past or short preparatory visit to help them process as many things prior to the visit where possible. This will help limit the amount of new information they need to process when making choices about their behaviour.

Using repetitive patterns of language, such as if... then... statements, can also children develop an awareness of possible consequences. This means that this is one less thing that they have to think up in a difficult situation.


Rehearsal

The importance of repetition and rehearsal has been discussed previously, but it is important to recognise the significance of role play in helping children develop self-awareness and problem-solving abilities. For young children, this may be done through dress-ups and dramatic play.

For children who struggle with imaginative play, using scripts will be important. That is, teach the child to use a set phrase or set of actions in response to a situation. Older children might want to help you design a screen play and video their new skill.


Visualise


Children with executive functioning issues will need help storing the information and skills, so they need a concrete reminder to carry around with them in case of "emergencies." Ways to do this include:

• A task card
• A social story
• A comic strip
  
• A picture sequence

The bottom line is to ensure that any visuals are small enough to carry in the child's pocket or on a lanyard or key ring. They need to be immediately accessible, but hard to lose.


Teach emotions

Help children get feedback from others around them by teaching them about body language and facial expressions. You can do this through books, videos, photos and picture strips (Dodd, 2005).

Recently I borrowed a great book called Sometimes I feel....: How to Help Your Child Manage Difficult Feelings by Dr. Samantha Seymour. Apart from the great hints and tips for parents/teachers at the beginning of the book, it is full of great photos of different facial expressions and body language. It also helps build awareness of what can cause someone to feel a certain way.

For example, pages 14-19 read:

Sometimes I feel angry... like when my mummy tells me I have to eat my breakfast before I can go outside and play. Or when it's my turn and my sister won't share."

These are accompanied by relevant photos of young children. This is a great book to help children recognise what can cause others to feel angry, sad, worried and so on. Knowing this can help them self-correct more effectively.

Dodd (2005) also discusses the usefulness of video modelling. This is effective as it can be played over and over again, and can demonstrate step-by-step a process of dealing with or responding to certain emotions.

Another great strategy highlighted by Dodd (2005) on page 187 are little picture cards that include an illustration of an emotion with relevant questions (see image adapted from her examples below).


Have a crisis management plan

It is important to also anticipate difficult emotions and situations when a child may not be able to cope. Have a plan for those times.

One of the strategies that has been discussed previously is the use of a feelings thermometer. This is a visual way of helping children recognise and manage difficult emotions.



Be proactive and positive

But most importantly, we should remember to always be proactive - prepare and anticipate in order to prevent negative events as much as possible - and positive, giving praise and positive reinforcement rather than focusing on "don'ts".



References:

Dodd, S. (2005). Understanding Autism. Sydney: Elsevier.

Oates, J. & Grayson, A. (2004). Cognitive and Language Development in Children. Blackwell Publishing: Oxford.

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To Include or not to include?

Special Education - "What's best for kids?" - as on seen on Weekend Sunrise Channel 7

And just as an additional note...

Article 23 of the UN Convention of the Rights of the Child (to which Australia is a signatory):

1. States Parties recognize that a mentally or physically disabled child [child with an intellectual or physical disability] should enjoy a full and decent life, in conditions which ensure dignity, promote self-reliance and facilitate the child's active participation in the community.

...

3. Recognizing the special needs of a disabled child, assistance extended in accordance with paragraph 2 of the present article shall be provided free of charge, whenever possible, taking into account the financial resources of the parents or others caring for the child, and shall be designed to ensure that the disabled child has effective access to and receives education, training, health care services, rehabilitation services, preparation for employment and recreation opportunities in a manner conducive to the child's achieving the fullest possible social integration and individual development, including his or her cultural and spiritual development.

And 4.2 of the Commonwealth Disability Standards for Education (2005) states:

(1)The education provider must take reasonable steps to ensure that the prospective student is able to seek admission to, or apply for enrolment in, the institution on the same basis as a prospective student without a disability, and without experiencing discrimination.

(2) The provider must ensure that, in making the decision whether or not to offer the prospective student a place in the institution, or in a particular course or program applied for by the prospective student, the prospective student is treated on the same basis as a prospective student without a disability, and without experiencing discrimination.

(3) The provider must:

(a) consult the prospective student, or an associate of the prospective student, about whether the disability affects the prospective student’s ability to seek admission to, or apply for enrolment in, the institution; and

(b) in the light of the consultation, decide whether it is necessary to make an adjustment to ensure that the prospective student is able to seek admission to, or apply for enrolment in the institution, on the same basis as a prospective student without a disability; and

(c) if:
(i) an adjustment is necessary to achieve the aim mentioned in paragraph (b); and
(ii) a reasonable adjustment can be identified in relation to that aim;
make a reasonable adjustment for the student in accordance with Part 3.

If you want to see the Facebook debate, visit http://www.facebook.com/group.php?gid=134329293268218

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Helping children adapt to change

Self-Correction:

"The ability to monitor and accurately evaluate performance and to make changes. Ability to learn from experience and feedback." (Queensland Health, 2007)

Problem-solving:

"The ability to recognise when the actions you are taking are ineffective, to stop, re-evaluate, and to formulate a plan." (Queensland Health, 2007)

Struggling with change

It would be simplifying things far too much to draw a direct link between executive functioning issues and children's difficulties adapting to change in their environment. However, it can play a significant part in this. But before I discuss the problem-solving and self-correction element of executive functioning, I want to look quickly at changes that children may find difficult to deal with, what behaviour they may display, and some other key factors that can contribute to difficulties adjusting to change.


What changes can cause difficulties?

There are many changes that can cause children with Autism Spectrum Disorders, anxiety disorders, depression, ADHD and even children who are chronically tired to feel threatened or anxious. These can include:

• New people
• Familiar people behaving differently
• Interrupted routines
• A favourite toy missing
  
• New sounds
• Moved furniture
• Complex, unpredictable interactions
  (Dodd, 2005; Oates and Grayson, 2004)
  

In fact, almost any change that a child with these difficulties is not prepared for will cause them distress.


What might you see?

Every child will have their own individual way of demonstrating that they aren't coping, or don't know what to do, when dealing with a change. Some examples:

• Meltdowns: I have talked about these in a previous post.
• Withdrawal
• "Stubborn" behaviour, or refusals. This often comes up in the context of children with Down Syndrome.
  

Executive functioning, self-correction and problem-solving

These elements of executive functioning, alongside the ability to plan and self-evaluate, help us adapt to the changes and complexities of life. As Oates and Grayson (2004) discuss, "the ability to switch flexibly between planned actions and different approaches to a task, without losing sight of the goals that are being aimed for, is a high-level cognitive function that is critically important in everyday life." (p214) That is, in order to cope with the many complexities of life - social, academic and physical - we need to be able to constantly evaluate, identify what is/is not working and adjust our behaviour accordingly.

When the executive functions aren't developed appropriately, then children will have difficulties adapting to change unexpected behaviour.

For example, imagine you are a child who loves playing in the sandpit with your two close friends. Ever since you have been at school the three of you have gone directly to the sandpit as soon as the recess bell has rung. Then one day you are heading out to the sandpit and one of your friends decides they want to join the hand-ball games instead.

You want your friend keep to your routine, so you say, "Come on! Aren't you coming to the sandpit?"

Your friend replies, "Nah. Today I feel like playing in the sandpit."

You say, "Aww. Come on! Let's play in the sand pit. We always do!"

Now, if you have a well-developed ability to self-analyse, self-correct and problem-solve, once you start noticing that your friend is becoming annoyed, you think about previous experiences, what you have been taught, how your behaviour is effecting them. You then correct your behaviour and problem-solve based on your goal of maintaining friendships ... which could mean you join the hand-ball game or go to the sandpit with your other friend.

If you have executive functioning difficulties, you would probably keep insisting that your friend maintain the routine. You may become aggressive in your attempts to maintain the routine (eg. pulling the child towards the sandpit) or have a meltdown as you are unable to work out what to do next since your routine has been broken.


Other reasons why children may struggle with change

• Theory of mind or social imagination (as discussed in a previous post) ... Not being able to interpret and respond appropriately to your social context will lead to difficulties with problem-solving and self-correction, or the ability to be flexible and adapt to your environment.
• Intellectual Disability ... a person's IQ is only one element of diagnosing an intellectual or developmental disability. The other element is an assessment of adaptive behaviour. As the American Association of Intellectual and Developmental Disabilities states, adaptive behaviour is about the ability to use language, social, conceptual and practical skills to live independently and according to the social expectations of our culture. It is therefore recognised that a person's cognitive development influences their ability to problem-solve and self-correct.
  

Next time....

Next time I will talk about ways to help children self-correct and problem-solve.



References:

Dodd, S. (2005). Understanding Autism. Sydney: Elsevier.

Oates, J. & Grayson, A. (2004). Cognitive and Language Development in Children. Blackwell Publishing: Oxford.

Queensland Health. (2007). Executive Function and Capacity. Retrieved 8th May, 2010 from http://www.health.qld.gov.au/abios/documents/behaviour_mgt/exec_functn_capacity.pdf.

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