Exploring the Challenges of ASD

In this section we will consider these challenges a little more closely and identify some strategies that may be used within the PlayConnect context to support and provide a wider breadth of understanding of the special conditions that apply in the ASD context.

Verbal and Non-Verbal Communication

Many children with ASD experience challenges with verbal and/or non-communication. Communication skills vary widely with children with ASD. In terms of verbal communication skills, some will have little or no speech while others will have well developed speech. Those with apparently ‘normal’ speech may find it difficult to communicate effectively, with particular difficulty with the pragmatics, or ‘social use’ of language. They may say unusual or socially inappropriate things, repeat words or phrases excessively, or focus on a specific topic for extended periods. Non-verbal communication skills will reflect similar variability. Some may struggle to make or maintain eye-contact, while others may have difficulty understanding non-verbal communication norms such as facial expressions and gestures.

As a result, those with ASD may communicate in different, or subtler ways, than neurotypical children. Some of the ways children with ASD communicate may include: behaviours such as tantrums, screaming and crying; looking or standing near an object they want; subtle variances in facial expressions or body language; holding of objects, pictures; speaking key words; echolalia; or excessive questioning.

Strategies to support children with communication difficulties may include:

  • Work to recognise all communication attempts and develop strategies specific to the child to respond appropriately
  • Use visuals and social stories to communicate messages more effectively
  • Get down to the child’s levelwhen communicating.
  • Break tasks down intosmall, approachable steps

Behaviours, Activities and Interests

We know those with ASD or ASD-like behaviours often engage in behaviours, activities and interests that may be considered unusual or atypical. These sorts or behaviours can manifest for a variety of reasons. They may act as coping strategies to lower anxiety when children are feeling frustrated, confused, excited, threatened or overwhelmed.

Alternatively, they may be comforting or pleasurable or may assist in expression or communication.

While they may serve a purpose, in some instances these behaviours can negatively impact a child’s health and well-being, and they may be quite challenging to manage.

These behaviours and interests can take many forms, though they generally fall into three broad categories:

  • Repetitive body movements
  • Restricted interests and ritualistic behaviours and
  • Sensory processing issues andassociated sensory seeking or avoidance behaviours

Below are some examples of these behaviours within each category, and some strategies that may be useful to manage these behaviours.

Repetitive Body Movements

Repetitive body movements include practices such as hand-flapping, spinning, rocking, and walking on tip-toes. These behaviours are common in response to strong emotions, such as excitement or worry, and can be self-stimulating or soothing.

Strategies to support children when engaging in repetitive body movements may include:

  • Reduce the environmental risk. Make sure there is adequate room around the childto keep them safe
  • Allow the child to retreat to a ‘quiet space’ when overwhelmed (don’t use quiet spaces when children are excited)
  • Help the child name the emotion. For example, if she is excited and hand flapping, use words to label the emotion. For example, ‘Oh wow you’re really excited! Bianca is really excited everyone’. This helps contextualise the behaviour for the children and group members

Restricted Interests and Ritualistic Behaviours

Restricted interests and ritualistic behaviours, such as obsessive play with particular objects, a need to adhere to a strict routine, or fixation on specific topics or objects is also common amongst those with ASD or ASD-like characteristics.

Although all children can have intense interests, the interest of children with ASD can be more intense and focused. These fixations can have both positive and negative consequences. On the positive side, interests and fixations can help a child feel more comfortable when conversing with others and can work towards supporting their confidence in social interactions. Alternatively, a child may become fixated on a particular interest (trains, animals, space, cars or dolls) to the exclusion of other objects, activity and attempts at social engagement. It is important to understand the role of the fixation, and to support the child in learning how to use appropriately by setting healthy boundaries.

Strategies to support children with intense interests and fixations may include:

  • Redirect them to the task at hand: ‘We’re talking about this now. We can talkabout trains at morning tea time’.
  • Use a visual schedule for what will happen in theday,delegating a time later for the child to play with their interest
  • Encourage ‘interest talk’ at morning tea, modelling ways to pause and listen to others to allow for learning in two-way conversation
  • Use interests to encourage interests in other activities. If a child was interested in trains, read books about trains, add trains to the sandpit etc.

Echolalia

Echolalia is a specific type of ritualistic behaviour that involves the repetition of words and phrases. It can be a form of verbal self-stimulation, signify language development, an attempt at new words, or a way for children to engage in social interaction.

Echolalia can present in various ways. For example, a facilitator may say to a child ‘let’s play with the ball’, to which he might respond ‘play with ball’ without any apparent meaning. It can also be delayed and may not occur immediately.

For example, if a child is asked what they did on the weekend, they might respond ‘don’t get sand in the car’ or ‘the goggles are blue’ repeating language heard on a day out at the beach. Otherwise, they may be unrelated to any discernible event but reflect the child’s interest or focus at that time. Either way, don’t discourage echolalia as it can be a sign of language development and an attempt at learning new words.

Strategies to support children with echolalia might include:

  • Help the child find new words and Using the ‘let’s play ball’ example, after he repeats “play ball”, you could answer the question ‘Yes, I would like to play ball, will you play with me’.
  • Model appropriate communication
  • Use key words and gestures to support development of vocabulary

Sensory Processing

Sensory processing difficulties occur when the brain misinterprets sensory information or is unable to organise it appropriately. Many with ASD or ASD-like characteristics experience sensory processing difficulties. Sensory processing refers to the ability to gather,understand, organise and use the information that comes to us from our senses.

We learn about our environment through the integration of our sensory systems:

  • auditory for hearing
  • visual for vision and sight
  • oral/gustatory for touch and taste in and around mouth; Olfactory for smell.

We learn about our body in the environment through integrated sensory systems:

  • tactile for touch and
  • our internal monitoring systems (vestibular for movement and balance; and proprioception and kinesthesia for body position).

Sensory processing difficulties occur when the brain misinterprets sensory information or is unable to organise it appropriately.

Sensory processing is the ability to gather, understand, organise and use the information that comes to us from our senses. Disorders of this type typically present in two key ways:

  • Under-responsiveness or sensory seeking
  • Over-responsiveness and sensory avoidant
  • Any of these issues can significantly impact the way an individual engages in the world around them, including the way they learn, play and behave.

Below is a brief summary of the behaviours and some strategies to providesupport.

Under-Responsiveness or Sensory Seeking

Under-responsiveness or sensory seeking behaviours involves a decreased response to sensory input. Individuals that process in this way:

  • may not appear to react to pain or have a high pain threshold;
  • may take longer to respond; may not appear to be listening; may require more intense input before noticing; and may be lethargic and uninterested in the world around them

In these cases, individuals often seek sensory input, such as rocking, spinning or climbing to increase the level of sensory input in a repetitive excessive way.

Some strategies to support sensory seeking behaviours may include:

  • Determine the type of sensory information the child is seeking
  • Provide the sensory input in an appropriate way
  • Divert attention from in appropriate action to sensory
  • Watch for signs of sensory overload and divert attention to quieter activities as appropriate

Over-Responsiveness and Sensory Avoidance

In cases of over-responsiveness and sensory avoidance, responses to sensory input are heightened. Those that process in this way may find some sensory stimulus (touch, taste, smell, sound) overwhelming. In some cases, a child may find a sensory stimulus so distressing they may actively look for ways to avoid it, known as sensory avoidance.

Some strategies to support sensory seeking behaviours may include:

  • Determine the type of sensory information thechildisavoidingorunder-responsive
  • Use a range of intense sensoryactivities to help engage

Sensory Over-Simulation

In a playgroup setting sensory over-stimulation can occur for numerous reasons, both to those who are over-responsive and under-responsive. It may be that the group is too loud or there are too many activities or toys to choose from. An activity could be causing over excitement and require wind down. There may be limited structure and constant changewithoutwarning,which may cause stress.

When children become over-stimulated, a group can begin to feel chaotic and cluttered. Children who become over-stimulated may begin to express this through behaviours such as screaming, tantrums or meltdowns.

Some strategies to avoid sensory overstimulation may include:

  • Creating predictable playgroup routine Childrenon the spectrum often have a preference for sameness and predictable routines. Organising time into set areas will help them to become more comfortable in the playgroup setting. Example of a playgroup routine can include:
    • Indoor play
    • Morning tea
    • Group time
    • Outdoor play
    • Home time
  • Provide fewer activities at once. Providing a large variety of activities can make for a cluttered environment and result in the stimulation of multiple sensory sensory systems. Limit the number of activities available to choose from at any one time.
  • Signal transitions between activities. Transition songs, sounds, visual aids and activities help children prepare for a change to in the environment. They can be used for all transition periods, including: pack away time at the end of indoor play, a move to morning tea; a move to group time; and to signal home time
  • Create a calm quiet space. A quiet space for children to move to when they are feeling over-stimulated should be provided at playgroup. A mat with some cushions or a tent and quiet soothing activities such as a few sensory toys may be provided to allow children to retreat when they are feeling overwhelmed.

Self-Injurious Behaviour

As well as repetitive and restrictive behaviours, children with ASD or ASD-like characteristics may engage in self-injurious behaviours, such as head banging, biting, pinching, self-rubbing or scratching. These behaviours can occur for many reasons. A child may be overcome by sensory input and use these behaviours to self-soothe, or they may use them to increase stimulation. They may also be associated with pain, either to alleviate some existing pain or communicating discomfort, or it may indicate a decreased pain response.  Alternatively, these behaviours can also be a way to express intense emotions like frustration, anger or anxiety, or excitement.

Strategies to support children engaging in self- injurious behaviour include:

  • Take note of what happens before and after the behaviour to identify a trigger, which can then be avoided in the future
  • If the behaviour has been caused by exposure to stimulus eg. light, loud sounds etc. remove thestimulus.
  • If due to overwhelming emotions, use a quiet space with sensory toys to help calm down children. Engage in calming activities
  • Unless the child is in danger to his/herself, avoid giving attention to the behaviour, as it may be reinforcing the behaviour. Rather, try to distract or redirect. Use praise to reinforce appropriate ways of expression.
  • As part of regular playgroup activities use play and resources to teach children about emotions and ways of self-regulating. For example, use visuals or social stories to teach children about strategies to bring calm, or emotional charades to learn names of feelings.

Social Awareness and Interactions

The final category of challenges often experienced by those with ASD and ASD-like characteristics relate to social awareness and appropriately engaging in social interactions with those around them. Specifically, those with ASD may have difficulty understanding facial expressions, initiating social interaction with others, responding to others in a social setting, and understanding and responding to others’ emotions. Some with ASD may also avoid social interactions because of anxiety or reduced interest around socialisation.

Given these potential difficulties, the development of social skills is vital for children with ASD.

These skills allow them to engage in meaningful relationships and in the social world around them. Below we look at some of specific social difficulties and some strategies to support the social skills of children with ASD or ASD-like characteristics.

Eye Contact

Children with ASD often find it difficult to attend to and coordinate two sources of sensory input at once. This can make eye contact while processing information difficult. To add to this, their challenges in interpreting social cues and facial expressions (especially in unfamiliar situations) may make them anxious and uncomfortable making eye contact.

Strategies to support increased eye contact include:

  • Develop a relationship with the child to make them feel comfortable with you. This may ease anxiety and enable them to be more comfortable making eye contact
  • Limit sensory input in an environment to avoid distraction
  • Build rewards into activities. For example, blow bubbles only when the child looks at you.

Joint Attention

Children with ASD often have a reduced ability to share experiences with others, or ‘ joint attention’. They may be engaged in their own thoughts and sensations and give less attention to those around them. As such, they may often miss the opportunity to share experiences with their peers.

Strategies to support increased joint attention include:

  • When interacting, get down to the child’s eye level
  • Join an activity that the child has initiated and model joint attention behaviour
  • If they are verbal, encourage children to direct you to something they are talking about. If they want to play with a particular toy, have them lead you to it and use your hand to physically instruct them to point

Turn Taking

Turn taking and sharing are complex social skills that many neurotypical children find challenging. This is often more so for children with ASD because of delayed understanding of social development and communication. Strategies to support turn taking behaviours might include:

  • Model turn taking and sharing by watching for spontaneous opportunities. For example, if a child is working on a puzzle, introduce a second child and allocate the pieces so each has half. Support them to take turns to complete the puzzle.
  • Use turn taking visuals such as a coloured circle with the words ‘my turn’ written on it, to be passed between children during a game. Children can only take their turn if they have the coloured circle.
  • Develop social stories to discuss the concept of turn taking and sharing with friends
  • Positively reinforce turn taking and sharing