Activity-Shifting: Helping Kids on the Autism Spectrum to Move Successfully from One Task to Another

"My child has a big problem with making transitions at home (school too). What methods do you use to help your child with autism (high functioning) to get accustomed to switching off one activity and on to another such as moving from a game to coming to the dinner table to eat with the rest of us?"

All children must switch from one task to another - and from one setting to another - throughout the day. At home and school, shifting naturally occurs frequently and requires children to stop one task, move from one spot to another, and begin a new task. Children with High-Functioning Autism (HFA) have greater difficulty in shifting attention from one task to another and changing routines.

This difficulty is due to a greater need for predictability, challenges in understanding what task will be coming next, and emotional discomfort when a routine is disrupted. A number of supports to assist children with HFA during activity-shifting have been designed to prepare these children before the transition will occur - and to support them during the shift. When shifting techniques are used, children with HFA increase appropriate behavior during shifting, participate more successfully in school and community outings, reduce the amount of time to shift, and rely less on adults for prompting.

Shifting techniques are used to support children with HFA during changes in - or disruptions to tasks, settings, or routines. The strategies can be used before an activity-shift occurs, during an activity-shift, and after an activity-shift – and can be presented verbally, auditorily, or visually. The techniques attempt to increase predictability for children with HFA - and to create positive routines around task-shifting, and they are used across settings to support these young people.

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

Task-shifting is a big part of any school day, as they move to different activities or locations. Research has indicated that up to 25% of a school day is spent engaged in transition activities, for example:
  • coming in from the playground
  • gathering needed materials to start working
  • going to the cafeteria
  • moving from classroom to classroom
  • putting personal items in designated locations (e.g., lockers)

Similar requirements for task-shifting are found at home as well, as these kids move from one task to another, attend functions, and join others for meals and activities.

Most children with HFA have problems associated with changes in routine and changes in environments. They have a strong need for “sameness” and predictability. These issues may eventually impede the child’s independence and limit his or her ability to succeed in community settings. A variety of factors related to the disorder contribute to these issues during task-shifting (e.g., problems in understanding the verbal directives or explanations that a teacher, parent, or employer are providing).

When a teacher announces that a task is finished and provides multi-step directions related to upcoming tasks, students with HFA often do not comprehend all of the verbal information. Difficulty sequencing information and recognizing relationships between steps of a task impact the child’s ability to transition as well.

These special needs kids often do not recognize the subtle cues leading up to a transition (e.g., packing up their materials, a teacher wrapping up her lecture, students getting their lunches out of the refrigerator, and so on) -- and may not be prepared when it is time to move. Also, children with HFA often have restrictive patterns of behaviors that are hard to disrupt, thus creating difficulty at times of task-shifting. Lastly, they often have greater anxiety, which can impact behavior during times of unpredictability.

The ongoing task may be more reinforcing to the HFA child than the task he or she is moving to – or a second task may be more demanding or unattractive. The child may not want to start one task or may not want to end another. Also, the attention the child receives during the transition-process may be reinforcing or maintaining the difficult behavior. 

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

Preparation Technique—

Cueing children with HFA before a transition is going to take place is a crucial strategy. In many settings, a simple 3 to 5 word “verbal-cue” can be used to signal an upcoming transition (e.g., “Time for a shower”, “Put your homework away”). This is the most effective way to signal a transition, because lengthy verbal information will not be quickly processed or understood.

NOTE:  Providing the cue immediately before the transition is “suppose” to occur may not be enough time for the child with HFA to shift attention from one task to the next. Allowing time for him or her to prepare for the task-shift, and providing more relevant cues that the youngster can refer to as he/she is getting ready to transition is much more effective. 

Along with developing predictable and consistent task-shifting routines, parents and teachers should also consider adjusting the activities that children on the autism spectrum are transitioning to and from if transition problems continue. Factors such as the length of a task, the difficulty level, and the interest level of the child all may contribute to transition problems.

Likewise, if an area is too crowded, loud, over-stimulating for some reason, these young people may resist transitioning to that location. An assessment of environmental factors that could contribute to transition problems is recommended here.

Furthermore, the sequence of activities should be assessed. Parents and teachers can benefit from reviewing the tasks required of the child throughout the day and categorizing them as (a) preferred, (b) non-preferred, or (c) neutral. If the youngster has difficulty transitioning, you can strategically sequence certain tasks so that he or she moves from non-preferred tasks to preferred tasks -- and from preferred tasks to neutral tasks.

Continually review how transitions impact the child with HFA. Depending on the task, environment, and his or her specific needs and strengths, a variety of transition techniques can be employed. Through the use of such techniques, children on the spectrum can more easily move from one task or location to another – and increase independence.

Several visual strategies used to support children with HFA in preparation for a transition have been researched and will be discussed in later posts (so stay tuned for more tips on this topic).

Click here for Part II of this article...


My 25-Year-Old HFA Son Is Not "Growing Up"

“My son with autism (high functioning) has recently turned 25. He still lives with us, he struggled in college and bailed out, can’t seem to find employment, has few friends (no girlfriend), is on his computer all day long (and through the night), refuses to seek the assistance of a job coach or other therapist. He's simply not 'growing up'. This is the same behavior we witness when he was a teenager. My question is, what happens typically in situations like this, where the person is now an adult with the disorder and seemingly unable to ‘make it’ out in the real world? What can we expect from our son as time goes by? Thanks in advance.”

Here are a few possible outcomes with respect to what may occur as your son continues to age:

1.    Behaviors that result from “mind-blindness” and a lack of understanding of non-verbal cues (e.g., body language, facial expression, etc.) can leave romantic partners (e.g., girlfriend, spouse) with the impression that the person with High-Functioning Autism (HFA) is self-absorbed and selfish. Relationship counseling from a professional well-versed in ASDs should be pursued if this case.

2.    Even the most mildly affected among young people with HFA face challenges in managing their symptoms (e.g., depression, low self-esteem, loneliness and anxiety are common problems). Applications for medical and psychological assistance can be pursued in this case.

3.    Often, young adults with HFA are misunderstood by those who lack experience with autism spectrum disorders. The HFA person’s lack of social awareness and interaction may be construed as odd or rude behavior.

Symptoms (e.g., inability to maintain eye contact during conversation) can make job interviews and establishing friendships difficult, as others often misinterpret the behavior as dishonesty or a lack of interest. Therefore, procuring the assistance of a job and/or life coach could be a real advantage in this situation.

4.    People with HFA suffer difficulties in communication, language, and social interaction typical of Autistic Disorder, as well as repetitive behaviors and narrow interests. Also, abstract language concepts, (e.g., irony and humor) may be beyond their comprehension. Thus, social skills training programs and/or seeking the assistance of a social skills therapist can be beneficial.

==> Launching Adult Children With Aspergers and HFA: How To Promote Self-Reliance

5.    While employees with HFA are very often extremely bright, focused, and talented, the social aspects of the workplace can be their undoing. Workplace friendships can be unfamiliar territory for those with social interaction difficulties, the small talk and humor beyond their grasp. Co-workers who are not aware of the difficulties faced by people on the spectrum may see them as awkward due to behavioral symptoms.

The person with HFA may be viewed as too serious, aloof, or arrogant because of repeated “social mistakes.” These misunderstandings can breed resentments among co-workers, causing dismissals by employers in order to keep peace in the workplace. In cases such as this, it’s best to self-disclose one’s disorder to the employer and request special accommodations when possible.

6.    On a positive note, many young people with HFA are able to blend into society just fine, learning to manage their symptoms to build successful and independent lives. Many find their niche in society with satisfying careers, successful marriages, fulfilling friendships, and active social lives. These “high-functioning” adults may not seem as if they have any autistic traits, sparing them the assumptions and prejudices faced by those with symptoms that are more obvious.


Reducing Hostility in Children on the Autism Spectrum

"When dealing with my autistic child (high functioning), I'm so often kept busy 'reacting' to his bad behavior - and it's hard to find the time to be proactive. I need a reminder about the necessity of this...just wish the schools would get on board and actually 'teach' our special needs kids what they 'should' be doing! In any event, my question is: how can I deal with my son's anger and rage?"

Hostility for many kids and teens with Aspergers or High-Functioning Autism (HFA) stems from the difficulty they have in communicating their needs to their educators, moms and dads, and peers. Aggressive behaviors are one way they have for conveying their needs and emotions to others. As their communication skills grow, continued violence may be the result of never having learned appropriate, non-aggressive ways of communicating when they were faced with a difficult situation. 

The cause of hostility may be due to any or all of the following:
  • Being placed in a stressful situation
  • Exhaustion
  • Extreme frustration
  • Inadequate speech development
  • Lack of adult supervision
  • Lack of routine
  • Mirroring the aggressive behaviors of other kids around them
  • Over-stimulation
  • Self-defense

The first step in managing hostility and aggression in kids with Aspergers and HFA is to understand what is causing it. Understanding the antecedents of a behavior (i.e., what happened before the behavior) will allow parents and teachers to better anticipate the likelihood a behavior problem will occur.

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's
Here are some questions that need to be answered:
  • How is the aggression expressed? Is it through words or behaviors? Does the child become verbally aggressive first, and then physically aggressive, or is the first response to strike out?
  • What seems to cause the aggressive behavior? Is it triggered by frustration, anger, or excitement? Are there patterns? Does the child act this way when toys are involved, and when he or she is frustrated about sharing? Or does the child become aggressive when there is too much going on and he or she is over-stimulated?
  • Where and when is the youngster most aggressive? A youngster on the autism spectrum may have difficulty coping with stress in unfamiliar or noisy locations, or when he is tired or overheated. Understanding where and when he becomes aggressive can provide important clues as to why the aggression is occurring.
  • Who does the youngster act aggressively towards? Is the target of her aggression one person in particular, or will she act aggressively to anyone who is around her? If it’s one person in particular, try to find out if there’s a reason why she’s attacking that person. Is there anything that the person does when he or she is around the youngster that causes the aggression to occur (e.g., overly-aggressive play, poor match of personalities, lack of clear-cut rules, loud voice, etc.)?

Collecting and analyzing data by getting answers to these questions is essential in developing a plan for coping with – and eliminating – aggressive behaviors in kids on the spectrum. Understanding the “function” of a particular behavior is the first step to (a) helping the youngster to be more aware of his angry feelings, (b) teaching him to calm himself down, and (c) finding alternative ways to solve his problems. Once parents and/or teachers have figured out why the youngster is behaving violently, it’s time to intervene.

Here are some concrete tips for dealing with hostility in children and teens with High-Functioning Autism:

1. At the first sign that a youngster is about to become hostile, immediately step-in and remove him from the situation. Be careful not to give too much attention to the youngster so that you do not give any negative reinforcement for the unwanted behavior. It can be useful to make a point of consoling the victim and ignoring the aggressor. If the youngster can’t calm down, remove him or her from the situation without getting angry yourself.

2. As grown-ups dealing with a hostile youngster, we need to demonstrate how to respond appropriately in stressful situations. Raising your voice tends to add stress to a difficult situation and will frequently result in an escalation of the behavior you are trying to stop.

3. Build the child’s language. If you can't get the HFA individual to be verbal, he should learn some sort of signs or picture system to give him some control over his life to communicate with people. That alone should help with a lot of behavioral issues. A variety of alternative communication devices, like the picture exchange communication system and other assistive technologies, enable an autistic youngster to express needs and desires.

4. Find out if the youngster has a comorbid condition influencing the aggressive behavior. A psychological or associated condition could be the root of the aggressive behavior. If that's the case, the youngster's behavior may need to be sorted out with a medical professional. In addition to seeking help from medical professionals, moms and dads should seek support from their own peers. It is important for parents of autistic children to get support from other parents of such children.

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

5. Just because you have taught a youngster to cope with some stressful situations does not mean you should continuously place the youngster in situations you know causes him difficulties. This means knowing when to leave a potentially volatile situation or choosing to engage the youngster in a different activity to avoid angry confrontations. Also, if the aggressive behavior always happens during a certain activity, such as when it's time to go, then have the youngster bring a preferred item with him to make the transition easier. Look at the situation in which the behavior is occurring and see if there is a way to change the dynamic in a way that will be less stressful for the youngster.

6. Moms and dads should look at the reason why their youngster is being aggressive. Is it to get attention, or to get out of something he doesn't want to do, or to obtain something he wants? Look at the function of why he is expressing aggression in order to address the behavior. Also, remember that any sort of reaction you give to the youngster could also be making the situation worse.

7. There are a number of anger-control practices you can work on before, during and after hostile episodes. It can be useful to: (a) count to ten to provide the youngster time to calm down; (b) recognize the emotions behind the anger (e.g., “I know you’re angry, but we don’t kick”); (c) encourage the youngster to use his words by making statements like “I am really mad right now!”; and (d) teach the youngster how to do deep breathing in order to calm down.

8. There is no “one-size-fits-all” treatment to address aggression in kids with an autism spectrum disorder . Treatments should be carefully developed and based on each particular youngster's unique situation. Treatment should be implemented by a qualified professional. Many times, aggression can be worsened by a well-intentioned, but inexperienced therapist.

9. When you catch your youngster being good, be sure to praise her hard work and efforts. Look for and continue to praise good behavior as a way to motivate her to do better next time.

10. While it is easy to think that a 5-year-old will outgrow aggression – or there is time to deal with it later – moms and dads need to imagine their youngster as a 15-year-old engaging in the same type of behavior. When you are at this point, there will be a lot fewer options, and if your youngster were to hurt somebody, even fewer options will be available.

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

Tips for therapists who deal with hostility in children and teens with High-Functioning Autism:

Addressing hostile behaviors in kids and teens with High-Functioning Autism can be a frustrating and demanding process for therapists. The challenge is to teach parents to “respond” to the unwanted behavior in a systematic manner (i.e., using approaches specifically tailored to children and teens on the spectrum) instead of “reacting” to it.

When these kids exhibit aggressive behaviors, they may not be receiving adequate support in mastering their environments (e.g., home, school). Aggressiveness does not necessarily reflect willfulness. Often the youngster simply lacks the social skills needed to get his or her needs met in a non-aggressive manner.

HFA children with earlier ages of onset of aggressiveness are more likely to meet diagnostic criteria for ADHD during childhood than children with later ages of onset of aggressiveness. Anxiety disorders have also been found to co-occur with aggressiveness at ‘higher than chance rates’ in childhood and adolescence.

Aggressive children need help in altering the way they process social information so that they do not interpret violence as justified or useful. The development of “voice” is an important component so that the child’s emotions can be put into words leading to social skill development, identifying feelings, fostering cooperation, emphasis on empathy, conflict resolution, and assertive communication. If an autistic youngster or teenager is not behaving in a positive manner, it is irrational to assume that they know more favorable alternatives.

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

Cognitive problem solving is useful in addressing aggression in kids on the spectrum. This method focuses on each youngster’s unique outlook to discover possible social skill deficits resulting in violence. 

The steps in cognitive problem solving are:
  1. encoding
  2. interpretation
  3. goal formulation
  4. response search and formulation
  5. response decision
  6. enactment

Each step requires different approaches to discovering and linking the missing skills in social situations. Developmental deficits in cognitive processes are often associated with early aggression, and normal social development requires mastery of cognitive and behavioral skills for assessing social circumstances, communicating with others, and resolving conflicts without aggressive behaviors. These skills empower HFA kids to make friends, succeed academically, and excel in the social world.

1. Encoding: Attending to social cues that are often missed or misinterpreted by aggressive kids.

Therapeutic Activities:
  • Kids make videos of their own cues and then explain their feelings on the basis of cues demonstrated in the video including facial expressions, voice intonation, hand gestures, and other indicators of social intent
  • Help kids identify their own feeling states through self-report and observation
  • Enhance sensitivity to verbal and nonverbal social cues through games and role-play, teaching kids to identify social cues in body language and pitch of voice

2. Interpretation: Assign meaning to social cues.

HFA kids commonly interpret neutral interactions as threatening – and then respond aggressively. These young people are not born knowing socially acceptable behaviors, and the level of their required assistance depends on the social supports they receive and their ability to absorb information.

Therapeutic Activities:
  • With the help of videos of playground activities, kids should be taught to identify the sources of the problems with emphasis on correctly identifying friendly, as well as antagonistic, intent on the part of peers
  • Kids should learn to identify and classify social cues by friendly, neutral, and antagonistic categories of intent. Younger kids might practice this through puppet play, and older kids might practice by assuming the roles of other kids in disputes

3. Goal Formulation: Define goals that enhance social relationships with an awareness of the consequences of behavior.

Therapeutic Activities:
  • Kids are rewarded for having ideas about goals for various situations (goals might be rated as to whether they are likely to augment or harm interpersonal relationships with peers)
  • Kids should be given opportunities to practice identifying and attaching pro-social goals to various situations

 ==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

4. Response Search and Formulation: Kids develop ideas about how to respond to each social circumstance they encounter.

Compared to neurotypical kids, HFA kids identify fewer alternatives and seem unaware of the various options that may be open to them when invited to participate in play or when confronted by a social problem. Remind parents that constantly telling kids on the spectrum what they are doing wrong is not beneficial, nor is it likely to improve future performance. Instead, these kids need help identifying their options and possible outcomes.

Therapeutic Activities:
  • Develop skills to control kid’s arousal and to create behavioral patterns in which aggression is only one of many responses
  • Increase a youngster’s skill in identifying alternatives to the use of aggression to solve social problems

5. Response Decision: Assess likely outcomes of aggressive behavior and select a response that can be characterized as assertive rather than violent.

Compared to neurotypical children, HFA kids tend to view pro-social responses less favorably. Thus, these young people are not behaving a certain way to annoy or harm others; rather, they are simply making decisions based on their limited of social skills.

Therapeutic Activities:
  • Evaluate the potential negative outcomes of each alternative
  • Evaluate the potential benefits of each alternative
  • Kids should be given opportunities to discuss likely gains and losses associated with each identified alternative in specific situations

6. Enactment: Apply a response.

This is where an aggressive youngster joins a group, offers and receives positive feedback, and learns to negotiate. Practicing these skills can be intimidating and challenging. Any attempts – successful or not – should be rewarded and reviewed to identify areas of strength, as well as areas for improvement.


Watching for Signs of High-Functioning Autism in Your Child

“I’ve known for some time that something is not quite right with my child, and I’m starting to wonder if he has an autism spectrum disorder. What should I look for?”

Learn the signs, and act early. Find out if your son’s development is on track, and learn the signs of developmental delays. Skills such as taking a first step, smiling for the first time, and waving "bye bye" are called developmental milestones. Kids reach milestones in how they play, learn, speak, behave, and move (e.g., crawling, walking, etc.). Track your son’s development and act early if you have a concern.

Here are the milestones that parents should look for if they are trying to track the possibility of an Autism Spectrum Disorder (ASD) in their child (ages 2 months - 5 years):

Baby at Two Months—

What most babies do at this age:
  • Begins to act bored (cries, fussy) if activity doesn’t change
  • Begins to follow things with eyes and recognize people at a distance
  • Begins to smile at people
  • Can briefly calm himself (may bring hands to mouth and suck on hand)
  • Can hold head up and begins to push up when lying on tummy
  • Coos, makes gurgling sounds
  • Makes smoother movements with arms and legs
  • Pays attention to faces
  • Tries to look at parent
  • Turns head toward sounds

Act early by talking to your youngster’s pediatrician if your youngster:
  • Can’t hold head up when pushing up when on tummy
  • Doesn’t bring hands to mouth
  • Doesn’t respond to loud sounds
  • Doesn’t smile at people
  • Doesn’t watch things as they move

What most babies do at this age:
  • Babbles with expression and copies sounds he hears
  • Begins to babble
  • Brings hands to mouth
  • Can hold a toy and shake it and swing at dangling toys
  • Copies some movements and facial expressions, like smiling or frowning
  • Cries in different ways to show hunger, pain, or being tired
  • Follows moving things with eyes from side to side
  • Holds head steady, unsupported
  • Lets you know if she is happy or sad
  • Likes to play with people and might cry when playing stops
  • May be able to roll over from tummy to back
  • Pushes down on legs when feet are on a hard surface
  • Reaches for toy with one hand
  • Recognizes familiar people and things at a distance
  • Responds to affection
  • Smiles spontaneously, especially at people
  • Uses hands and eyes together, such as seeing a toy and reaching for it
  • Watches faces closely
  • When lying on stomach, pushes up to elbows

Act early by talking to your youngster’s pediatrician if your youngster:
  • Can’t hold head steady
  • Doesn’t bring things to mouth
  • Doesn’t coo or make sounds
  • Doesn’t push down with legs when feet are placed on a hard surface
  • Doesn’t smile at people
  • Doesn’t watch things as they move
  • Has trouble moving  one or both eyes in all directions

Your Baby at Six Months—

What most babies do at this age:
  • Begins to pass things from one hand to the other
  • Begins to say consonant sounds (jabbering with “m,” “b”)
  • Begins to sit without support
  • Brings things to mouth
  • Knows familiar faces and begins to know if someone is a stranger
  • Likes to look at self in a mirror
  • Likes to play with others, especially parents
  • Looks around at things nearby
  • Makes sounds to show joy and displeasure
  • Responds to other people’s emotions and often seems happy
  • Responds to own name
  • Responds to sounds by making sounds
  • Rocks back and forth, sometimes crawling backward before moving forward
  • Rolls over in both directions (front to back, back to front)
  • Shows curiosity about things and tries to get things that are out of reach
  • Strings vowels together when babbling (“ah,” “eh,” “oh”) and likes taking turns with parent while making sounds
  • When standing, supports weight on legs and might bounce

Act early by talking to your youngster’s pediatrician if your youngster:
  • Doesn’t laugh or make squealing sounds
  • Doesn’t make vowel sounds (“ah”, “eh”, “oh”)
  • Doesn’t respond to sounds around him
  • Doesn’t roll over in either direction
  • Doesn’t try to get things that are in reach
  • Has difficulty getting things to mouth
  • Seems very floppy, like a rag doll
  • Seems very stiff, with tight muscles
  • Shows no affection for caregivers

What most babies do at this age:
  • Can get into sitting position
  • Copies sounds and gestures of others
  • Crawls
  • Has favorite toys
  • Looks  for things he sees you hide
  • Makes a lot of different sounds like “mamamama” and “bababababa”
  • May be afraid of strangers
  • May be clingy with familiar adults
  • Moves things smoothly from one hand to the other
  • Picks up things like cereal o’s between thumb and index finger
  • Plays peek-a-boo
  • Pulls to stand
  • Puts things in her mouth
  • Sits without support
  • Stands, holding on
  • Understands “no”
  • Uses fingers to point at things
  • Watches the path of something as it falls

Act early by talking to your youngster’s pediatrician if your youngster:
  •  Doesn’t babble (“mama”, “baba”, “dada”)
  • Doesn’t bear weight on legs with support
  • Doesn’t look where you point
  • Doesn’t play any games involving back-and-forth play
  • Doesn’t respond to own name
  • Doesn’t seem to recognize familiar people
  • Doesn’t sit with help
  • Doesn’t transfer toys from one hand to the other

Your Youngster at One Year—

What most kids do at this age:
  • Bangs two things together
  • Copies gestures
  • Cries when mom or dad leaves
  • Explores things in different ways, like shaking, banging, throwing
  • Finds hidden things easily
  • Follows simple directions like “pick up the toy”
  • Gets to a sitting position without help
  • Hands you a book when he wants to hear a story
  • Has favorite things and people
  • Is shy or nervous with strangers
  • Lets things go without help
  • Looks at the right picture or thing when it’s named
  • Makes sounds with changes in tone (sounds more like speech)
  • May stand alone
  • May take a few steps without holding on
  • Plays games such as “peek-a-boo” and “pat-a-cake”
  • Pokes with index (pointer) finger
  • Pulls up to stand, walks holding on to furniture (“cruising”)
  • Puts out arm or leg to help with dressing
  • Puts things in a container, takes things out of a container
  • Repeats sounds or actions to get attention
  • Responds to simple spoken requests
  • Says “mama” and “dada” and exclamations like “uh-oh!”
  • Shows fear in some situations
  • Starts to use things correctly; for example, drinks from a cup, brushes hair
  • Tries to say words you say
  • Uses simple gestures, like shaking head “no” or waving “bye-bye”

Act early by talking to your youngster’s pediatrician if your youngster:
  • Can’t stand when supported
  • Doesn’t crawl
  • Doesn’t learn gestures like waving or shaking head
  • Doesn’t point to things
  • Doesn’t say single words like “mama” or “dada”
  • Doesn’t search for things that she sees you hide
  • Loses skills he once had

Your Youngster at Eighteen Months—

What most kids do at this age:
  • Can follow 1-step verbal commands without any gestures; for example, sits when you say “sit down”
  • Can help undress herself
  • Drinks from a cup
  • Eats with a spoon
  • Explores alone but with parent close by
  • Knows what ordinary things are for; for example, telephone, brush, spoon
  • Likes to hand things to others as play
  • May be afraid of strangers
  • May cling to caregivers in new situations
  • May have temper tantrums
  • May walk up steps and run
  • Plays simple pretend, such as feeding a doll
  • Points to get the attention of others
  • Points to one body part
  • Points to show others something interesting
  • Points to show someone what he wants
  • Pulls toys while walking
  • Says and shakes head “no”
  • Says several single words
  • Scribbles on his own
  • Shows affection to familiar people
  • Shows interest in a doll or stuffed animal by pretending to feed
  • Walks alone

Act early by talking to your youngster’s pediatrician if your youngster:
  • Can’t walk
  • Doesn’t copy others
  • Doesn’t gain new words
  • Doesn’t have at least 6 words
  • Doesn’t know what familiar things are for
  • Doesn’t notice or mind when a caregiver leaves or returns
  • Doesn’t point to show things to others
  • Loses skills he once had

What most kids do at this age:
  • Begins to run
  • Begins to sort shapes and colors
  • Builds towers of 4 or more blocks
  • Climbs onto and down from furniture without help
  • Completes sentences and rhymes in familiar books
  • Copies others, especially adults and older kids
  • Finds things even when hidden under two or three covers
  • Follows simple instructions
  • Follows two-step instructions such as “Pick up your shoes and put them in the closet.”
  • Gets excited when with other kids
  • Kicks a ball
  • Knows names of familiar people and body parts
  • Makes or copies straight lines and circles
  • Might use one hand more than the other
  • Names items in a picture book such as a cat, bird, or dog
  • Plays mainly beside other kids, but is beginning to include other kids, such as in chase games
  • Plays simple make-believe games
  • Points to things in a book
  • Points to things or pictures when they are named
  • Repeats words overheard in conversation
  • Says sentences with 2 to 4 words
  • Shows defiant behavior (doing what he has been told not to)
  • Shows more and more independence
  • Stands on tiptoe
  • Throws ball overhand
  • Walks up and down stairs holding on

Act early by talking to your youngster’s pediatrician if your youngster:
  • Doesn’t copy actions and words
  • Doesn’t follow simple instructions
  • Doesn’t know what to do with common things, like a brush, phone, fork, spoon
  • Doesn’t use 2-word phrases (for example, “drink milk”)
  • Doesn’t walk steadily
  • Loses skills she once had

Your Youngster at Three Years—

What most kids do at this age:
  • Builds towers of more than 6 blocks
  • Can name most familiar things
  • Can work toys with buttons, levers, and moving parts
  • Carries on a conversation using 2 to 3 sentences
  • Climbs well
  • Copies a circle with pencil or crayon
  • Copies adults and friends
  • Does puzzles with 3 or 4 pieces
  • Dresses and undresses self
  • Follows instructions with 2 or 3 steps
  • May get upset with major changes in routine
  • Names a friend
  • Pedals a tricycle (3-wheel bike)
  • Plays make-believe with dolls, animals, and people
  • Runs easily
  • Says first name, age, and sex
  • Says words like “I,” “me,”  “we,” and “you” and some plurals (cars, dogs, cats)
  • Screws and unscrews jar lids or turns door handle
  • Separates easily from mom and dad
  • Shows a wide range of emotions
  • Shows affection for friends without prompting
  • Shows concern for crying friend
  • Takes turns in games
  • Talks well enough for strangers to understand most of the time
  • Turns book pages one at a time
  • Understands the idea of “mine” and “his” or “hers”
  • Understands what “two” means
  • Understands words like “in,” “on,” and “under”
  • Walks up and down stairs, one foot on each step

Act early by talking to your youngster’s pediatrician if your youngster:
  • Can’t work simple toys (such as peg boards, simple puzzles, turning handle)
  • Doesn’t make eye contact
  • Doesn’t play pretend or make-believe
  • Doesn’t speak in sentences
  • Doesn’t understand simple instructions
  • Doesn’t want to play with other kids or with toys
  • Drools or has very unclear speech
  • Falls down a lot or has trouble with stairs
  • Loses skills he once had

Your Youngster at Four Years—

What most kids do at this age:
  • Can say first and last name
  • Catches a bounced ball most of the time
  • Cooperates with other kids
  • Draws a person with 2 to 4 body parts
  • Enjoys doing new things
  • Hops and stands on one foot up to 2 seconds
  • Is more and more creative with make-believe play
  • Knows some basic rules of grammar, such as correctly using “he” and “she”
  • Names some colors and some numbers
  • Often can’t tell what’s real and what’s make-believe
  • Plays “Mom” and “Dad”
  • Plays board or card games
  • Pours, cuts with supervision, and mashes own food
  • Remembers parts of a story
  • Sings a song or says a poem from memory such as the “Itsy Bitsy Spider” or the “Wheels on the Bus”
  • Starts to copy some capital letters
  • Starts to understand time
  • Talks about what she likes and what she is interested in
  • Tells stories
  • Tells you what he thinks is going to happen next in a book
  • Understands the idea of “same” and “different”
  • Understands the idea of counting
  • Uses scissors
  • Would rather play with other kids than by himself

Act early by talking to your youngster’s pediatrician if your youngster:
  • Can’t jump in place
  • Can’t retell a favorite story
  • Doesn’t follow 3-part commands
  • Doesn’t understand “same” and “different”
  • Doesn’t use “me” and “you” correctly
  • Has trouble scribbling
  • Ignores other kids or doesn’t respond to people outside the family
  • Loses skills he once had
  • Resists dressing, sleeping, and using the toilet
  • Shows no interest in interactive games or make-believe
  • Speaks unclearly

What most kids do at this age:
  • Wants to please friends
  • Wants to be like friends
  • More likely to agree with rules
  • Likes to sing, dance, and act
  • Shows concern and sympathy for others
  • Is aware of gender
  • Can tell what’s real and what’s make-believe
  • Shows more independence (for example, may visit a next-door neighbor by himself)
  • Is sometimes demanding and sometimes very cooperative
  • Speaks very clearly
  • Tells a simple story using full sentences
  • Uses future tense; for example, “Grandma will be here.”
  • Says name and address
  • Counts 10 or more things
  • Can draw a person with at least 6 body parts
  • Can print some letters or numbers
  • Copies a triangle and other geometric shapes
  • Knows about things used every day, like money and food
  • Stands on one foot for 10 seconds or longer
  • Hops; may be able to skip
  • Can do a somersault
  • Uses a fork and spoon and sometimes a table knife
  • Can use the toilet on her own
  • Swings and climbs

Act early by talking to your youngster’s pediatrician if your youngster:
  • Can’t brush teeth, wash and dry hands, or get undressed without help
  • Can’t give first and last name
  • Can’t tell what’s real and what’s make-believe
  • Doesn’t draw pictures
  • Doesn’t play a variety of games and activities
  • Doesn’t respond to people, or responds only superficially
  • Doesn’t show a wide range of emotions
  • Doesn’t talk about daily activities or experiences
  • Doesn’t use plurals or past tense properly
  • Is easily distracted, has trouble focusing on one activity for more than 5 minutes
  • Loses skills he once had
  • Shows extreme behavior (unusually fearful, aggressive, shy or sad)
  • Unusually withdrawn and not active

A word about the importance of further research:

We need to know how many kids have Autism Spectrum Disorders (ASD) so that realistic plans can be made to support these youngsters and their parents. Knowing the number of kids who have ASDs is the key to promoting awareness of the disorder, helping teachers and health-care providers to plan and coordinate service delivery, and identifying important clues for further research. If service providers are not prepared to meet the needs of children with ASD, it takes a toll on families.

Families living with ASD have unique stresses. For example:
  • Annual medical expenditures per youngster with an ASD range from $2,100 to $11,200.
  • Intensive behavioral interventions for a youngster with an ASD can cost from $40,000 to $60,000 per year.
  • Many parents report having to stop work to care for their child with an ASD.
  • The cost to individual families extends into lost productivity and other financial problems for communities.
  • The nonmedical costs of special education for a youngster with an ASD are about $13,000 per year.
  • Therapies are expensive and families spend time on long waiting lists.

Researchers have used different ways to estimate the prevalence of ASD, and each method has advantages and disadvantages. Here’s a summary of each method:

1. Administrative Data: Looking at service records from Medicare and agencies like the U.S. Department of Education. Relatively low cost, BUT underestimates prevalence because not all kids with ASDs are receiving services for their conditions.

2. Population Screening and Evaluation: Screening and evaluating a sample of all kids in a population. Can provide high accuracy, BUT can be costly and time-consuming, and might reflect a bias based on who participates.

3. Registries: Voluntarily including oneself (or one’s son or daughter) on a list of individuals with ASDs. Relatively low cost, BUT time consuming and includes only people with a clear diagnosis and families who know about the registry and are willing to be on the list.

4. Systematic Record Review: Cost-effectively provides estimate of the prevalence of ASDs from large communities and identifies kids who might not have a clear ASD diagnosis already; BUT, it relies on the quality and quantity of information in records.

Key findings from the most recent research:
  • A small percentage of kids who are born prematurely or with low birth weight are at a greater risk for having ASDs.
  • About 1 in 88 kids have ASD, although some estimates say it is closer to 1 in 50.
  • About 10% of kids with ASDs also have been identified as having Down syndrome, fragile X syndrome, tuberous sclerosis, or other genetic and chromosomal disorders.
  • Almost five times as many boys are being identified with ASDs as girls (1 in 54 compared to 1 in 252).
  • ASDs tend to occur more often among children who have certain genetic or chromosomal conditions.
  • Both genetic and non-genetic factors play a role in whether or not a child will have an ASD.
  • Kids born to older parents also are at a higher risk of having an ASD.
  • Kids who have a sibling or parent with an ASD are at a higher risk of having an ASD.
  • More kids are diagnosed at earlier ages—a growing number of them by 3 years of age. Still, most kids are not diagnosed until after they are 4 years of age.
  • More kids than ever before are being diagnosed with ASDs, but they are not being diagnosed as early as they could be.
  • The emotional and financial tolls on families and communities are staggering, and therapies can cost thousands of dollars.
  • The largest increases over time have been among Hispanic and Black kids. Some of this may be due to better screening and diagnosis.
  • The majority (62%) of kids identified as having ASDs do not have intellectual disability.
  • When taken during pregnancy, the prescription drugs valproic acid and thalidomide have been linked with a higher risk of ASDs. 

More resources for parents of children and teens with High-Functioning Autism and Asperger's:  

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Highly Effective Research-Based Parenting Strategies for Children with Asperger's and High-Functioning Autism

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism


Teaching the Anxious Student on the Autism Spectrum: 25 Tips for Parents and Teachers

Teaching students with Aspergers or High-Functioning Autism (HFA) who also experience social anxiety in the classroom WILL be challenging. School can be difficult for these special needs students without the anxiety issue, but it is especially difficult for the anxious child on the spectrum. 
If you are a parent or teacher of an anxious student with the disorder, knowing how to encourage and foster a good environment for learning is paramount.

There is no one sign that indicates that an HFA student has social anxiety. However, some common signs include:
  • appearing very anxious when the center of attention
  • being constantly alone in the playground
  • clinging
  • crying for no apparent reason
  • devoting an excessive amount of time to the computer
  • experiencing severe anxiety about tests and quizzes
  • freezing for no apparent reason
  • frequent claims of illness so as to avoid going to school
  • having no friends, or having only one friend
  • hovering on the edge of groups
  • not joining in
  • poor eye contact
  • refusing to go to school 
  • saying very little or even nothing during class
  • speaking very softly
  • throwing tantrums or experiencing meltdowns
  • unwillingness to participate in class activities (e.g., show and tell, debating, reading aloud, raising their hand to answer and ask questions, etc.)

If you have a student in class who is experiencing social anxiety, here are some ideas for assisting him or her:

1. Allow HFA children to take a "break" (e.g., go get a drink) if they seem to become overwhelmed

2. Allow the child to arrive late if it makes the transition easier.

3. Allow the him or her to sit with classmates that he/she is familiar with or is friends with.

4. Assign a "lifeline" peer to the HFA youngster who can help answer his/her questions if called upon in a group setting.

6. Develop and follow a regular predictable classroom routine.

7. Embarrassment is a concern for all adolescents, but is multiplied in teens on the spectrum experiencing anxiety. Modifications and adaptations should be in place with subtle non-intrusive methods to allow the teen to maintain a sense of dignity and responsibility. Blatant, harsh criticisms of these adolescents will perpetuate their fears of failure and feed into their cycles of anxiety and avoidance.

8. Encourage completion of activities and assignments, yet allow extra time when needed.

9. Encourage friendships between kids on the autism spectrum and friendly, outgoing classmates.

10. Encourage the child to keep a written log of assignments and due dates.

11. Ensure that you have a zero tolerance rule for bullying and discrimination of any kind. Have consequences in place for children who embarrass or humiliate other kids to prevent this behavior in the classroom (e.g., during speeches, any youngster who snickers during another child's speech would have marks deducted from his/her own grade).

12. For younger kids on the spectrum, make the student your special helper to give him/her a role in the classroom.

13. For younger kids on the spectrum, read storybooks about self-esteem and bullying. For older kids read novels or watch movies with the same content.

14. Have a preset time each week that the child can talk with you or another staff member about how he is feeling and his fears.

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

15. Help the child confront feared situations with gentle encouragement.

16. Identify a "safe place" that the child can go to if feeling overwhelmed, and have a signal and exit strategy for these situations.

17. If an autistic child misses a lot of school due to social anxiety, allow gradual reintroduction at a pace that the child is comfortable with.

18. If possible, decrease homework load.

19. In your interactions with the child, speak softly and calmly.

20. Modify instructional methods if necessary (e.g., explaining an assignment one-on-one with the child).

21. Pair children for activities rather than allowing children to choose pairs, to prevent the child with HFA from being left out.

22. Promote self-esteem by offering praise for small accomplishments and rewarding participation even if the child gives a wrong answer.

23. Regular meetings between parents, teachers, counselors and other school staff are important for planning classroom strategies for the special needs child.

24. Team with parents to develop calming techniques and relaxation strategies.

25. The child may require social skills training or instruction in relaxation techniques delivered by a special education teacher or other team member.

Note to Parents: If your child experiences social anxiety in a school setting, feel free to copy, paste, and print this article for your child's teachers.

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism 

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