pervasive developmental disorders – Gabe Feathers McGee

visual schedule2 — visual schedule (on the far right)

When a child is diagnosed with Autism Spectrum Disorder (ASD), therapists often suggest that parents develop a visual schedule. I thought this seemed a little strange when I was told to do it by my son’s speech pathologist, but went along for the ride ;). It turns out to be one of the most effective strategies you can use with ASD children.

What is a visual schedule?

A visual schedule is a series of pictures arranged on a board (or in a notebook, on a computer, or other device) that show the child what will be happening during a specific time period (usually a day).

Why are they used?

ASD children often experience the world as chaotic and confusing and subsequently have a greater need for structure and predictability in their life. The visual schedule can assist the child in understanding what is planned for the day or week and therefore provide this structure.

ASD children (and adults) often prefer the visual over auditory and the use of pictures helps them realise what will be happening next (in the absence of the ability to read or comprehend speech).

How do you make one?

There are many ways to make a visual schedule.

When my son needed a visual schedule around the age of three, I glued felt onto a wooden board and divided the board into the 7 days of the week (using coloured strips to divide the week and the name of the days at the top of each section). I am not a crafty person so this was no mean feat 🙂

Some people prefer to have one day, instead of the whole week. Some will even have a shedules for part of the day (eg., at kindergarten).

I used clipart from the internet and photos (laminated and with a Velcro dot on the back of each picture) and anything else I could get my hands on, for use on the felt board. The picture is easily placed on the schedule using the velcro backing. Note: a laminator was a good investment, back then, and most of the parents from the early intervention centre invested in one ;).

I would place the pictures on the schedule in the morning (or night before when my son was asleep) so that he could see what was happening on that one day (I would leave the other 6 days blank except for a picture of kindergarten or home).

When the activity (eg., swimming lesson, lunch) is finished, the laminated picture can be removed (or crossed out with a laminated X). Most ASD children find this process of indicating the completion of an activity, very satisfying.

There are endless ways of making visual schedules (use your imagination). Some use laminated strips with velcro dots attached to a desk (at school), or on the board. Today the Ipad is being used for similar tasks with great success for ASD children.

How long do you use a visual schedule?

This depends on the child and the severity of the ASD.

My son now uses calendars, diaries and lists of activities (as he can now read and write) to assist in managing his day. We still use some visual schedules combined with text for important routines including 1. What to do before school in the morning; and 2. What to do before going to bed.

The internet is also a great source of information for finding clipart, images, and ways to make visual schedules.

Good luck!

ps. I am a great believer that schools should include visual schedules for all children, as everyone can benefit from schedules, especially young children.

Early Warning Signs: The Autism Files

If your child has Autism Spectrum Disorder (ASD) early diagnosis is very important.

Why is it important?

Because intensive early intervention is effective for young children with ASD (the window of opportunity is approximately the ages of 2 to 6) and the earlier the diagnosis and treatment, the better the prognosis*.

My son was diagnosed with autism soon after his third birthday but when I look back, the signs were there shortly after birth. He was a difficult baby and a difficult child – beautiful and wonderful, but difficult. The nurses in the maternity ward could not believe the noise a 3 day old baby could make (crying for hours while most of the other newborns were peacefully sleeping). Most babies settle after a feed – Michael had difficulty feeding and often cried more after a feed.

Doctors blamed it all on GORD (gastro-oesophageal reflux disease) or heartburn and to some extent they were right – Michael did have reflux and there was some improvement when medication was introduced for GORD. But we still had to deal with regular screaming fits, often a couple of hours after he had fallen asleep. Michael would wake up crying most nights in his first 9 years (he is now 10) – he would wake up scared and inconsolable, often sweating and heart racing.

Michael did not respond to his name until he was nearly 4- it was as if he was deaf (and we did get his hearing tested, just in case). People would wave at my son, but he would never wave back (not until about the age of 5). He would not point or make meaningful gestures or ask for things (the way he got my attention was by crying or screaming).

Michael had an excellent memory and an extensive vocabulary from a young age, but there was almost no communication. He would repeat huge chunks of speech from books, videos, and people, but had no idea what it meant.

He had a very strange way of playing. He would line up toys, categorise toys, spin wheels and parts of toys for long periods of time as if studying the mechanism of the toy. He would spin around on chairs or on his feet and laugh hysterically. He was obsessed with spinning fans, switching lights on and off over and over again, running taps, flushing toilets and other forms of moving water.

His behaviour would become increasingly odd when he was stressed (a new place, an overcrowded shopping centre, birthday parties etc.). We visited a friend one day (somewhere he had never been before) and after half an hour Michael proceeded to walk backwards through the whole house. He would do running circuits around our house when stressed. Repetition was Michael’s best friend.

Michael was an extremely limited and fussy eater with rigid rules (sandwich must be cut exactly in half, no foods must touch each other, all foods eaten separately – sandwiches would be carefully dismantled and eaten bit by bit, very limited number and types of foods, eating the same foods over and over for years). Deviations from the food rules would result in tantrums from hell and numerous circuits of the house.

Michael would avoid looking people in the eye and often used his peripheral vision (would ride a bike or run while holding his head on a right angle to his body – he never ran into anything)!

Michael hated places that create sensory overload, especially shopping centres where there is too much noise, too many smells, too many people, too many things! Next time you are shopping and standing at the checkout, take stock of all the sensory stuff happening at the counter (ringing bells, smell of food mixed with cleaning products, pushy people with body odour or too much perfume, flicking fluorescent lights etc. ) and multiply what you experience by a factor of 10 to 20, and that will go a small way to your understanding of what a person with ASD has to put up with when going out.

Michael had other sensory issues. He was sensitive to sounds (vacuum cleaners, hand driers, unexpected noises), smells, light touch (he loved heavy touch and big hugs). We had huge problems with things like washing hair, cutting hair, cleaning teeth.

Michael also had a range of physical issues that are signs of ASD. He had a rather large head circumference (and research has shown that accelerated head growth is an indicator of autism) and he had issues with balance and coordination that became increasingly obvious after assessment by occupational therapists.

I didn’t think Michael had autism. My mother asked me to watch a show about autism on the television when Michael was two. I wondered why she wanted me to watch it. Mum knew a lot about children, having four of her own and having also worked with children and orphans as a mother-craft nurse. She knew that something wasn’t quite right.

As a psychologist I had briefly studied autism at University (about 10 minutes in a Developmental Psychology lecture) and the presentation was all about severely autistic boys who couldn’t even hug their parents (in fact most autistic children are not averse to a hug). I did not relate that lecture to my child one little bit.

Parents who are concerned about their child’s development should consult with their GP or paediatrician. Many of the early warning signs for ASD are not specific to ASD and a comprehensive assessment is required to identify any problems.

Parents (and other family members) know their children better than anyone else. If you feel something is not quite right, than you should follow your instincts and seek out assistance. It should be noted that doctors and paediatricians do not get it right all the time.

My boy’s paediatrician thought three years old was too young for a diagnosis (but best practice says diagnoses can and should be made much earlier). I had to really convince Michael’s doctors that there was an issue to be addressed.

Michal received intensive early intervention at the AEIOU and is now doing very well, attending a mainstream school and doing above average academically. He has difficulty with social issues but continues to improve.

Follow this link for more information on the early signs of autism.

* Early intervention is optimal, but improvements can also be made in the later years (it is never too late to intervene).