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Up a Creek Without an Idiom

By Tori Gallagher

Editor’s Note: A few issues ago (Jan 2006) we ran Tori’s article, “What I Know About George” and it was so well received, we asked Tori to write a second (and third!) piece for the Digest. Here’s more about George!

A couple of months ago George’s homework assignment was to come up with five idioms. Now I know there are whole books written on the subject of teaching figurative language to kids like George, kids on the ASD spectrum. And I don’t have one.

What I did have was two - just two - examples provided by the teacher:

1) George will be “on thin ice” if he doesn’t finish his homework.

2) “Hold your horses,” George!

The teacher did not provide a definition of an idiom. So I gave it a shot.

“Okay, George,” I say. “An idiom is an expression that…uh, well…that doesn’t match the literal meaning of the words.” I was rather pleased with that. I looked at George. Blank look.

“Do you understand, George?”

“What’s an expression?” he asks.

“It’s…well…a way of saying something.” George blinks.

“What’s literal?”

“Uh… it’s when words don’t mean exactly what they…uh…mean. Look, people use idioms all the time in conversation but they don’t mean exactly what they’re saying.” George’s eyes widen.

“They’re LYING?”

“No, no honey. It’s just that…well…What do you say we find a dictionary?”

So I looked up “idiom” hoping for a concise, kid-friendly definition that would help make it clear to George. My Webster’s defines “idiom” as follows:

A speech form or expression of a language that is peculiar to itself grammatically or that cannot be understood from the individual meanings of its elements.

George was trying to peer over my shoulder.

“So what does it say?”

“Let’s find another dictionary,” I say. The second dictionary defines “idiom” as:

A phrase, construction or expression that is recognized as a unit in the usage of a given language and either differs from the usual syntactic patterns or has a meaning that differs from the literal meaning of its parts taken together.

I shut the book.

“Okay, George, what were those examples your teacher provided?”

So we talked about the examples and what they meant. He seemed to get it and was even pleased at the whole idea of saying silly things and all.

“So George,” I say and put his paper in front of him, “can you think of an idiom now?”

“Hold your horses?” he says.

“Yes, honey, but that’s one of your teacher’s examples. Can you think of one of your own?” Blank look. Furrowed brow. “Okay, why don’t you just think about it for awhile.”

I walk away, go fold some laundry in the next room, and come back five minutes later. George is doing his boneless boy impression at the kitchen table (kind of looks like one of those melting clocks in a Salvador Dali painting). I look at his paper; it is blank.

“George, it’s not so hard, really. We use them all the time. You just have to think about it.” By now he is red in the face and about to slide out of his chair.

“Okay, let’s try one more example.” I think hard. Honestly I’m having a hard time thinking of an idiom on command. “Okay, I have one. Let’s say you asked me if you could stay home all next week and play Nintendo instead of going to school and I said ‘When pigs fly.’ What do you think that would mean?” He perks up.

“Yes?” he says hopefully.

“Honey, when have you ever seen pigs flying?”

“Well, in Donkey Kong there are pigs with wings who…”

“George that’s a video game. In real life.” He deflates again.

“I don’t know,” he says in a small voice.

“Pigs don’t fly, honey. The answer is never. It’s an idiom.”

“Oh,” he says and melts onto the table again.

“Okay, maybe that was a bad example,” I say. By now he’s slipped down in his chair so that only his little face is showing above the table. “Tell you what honey, why don’t you go watch cartoons with your brother…” I catch him as he tries to bolt out of the room. “But I want you to listen to what the characters are saying and see if you can pick out an idiom.” He agrees and flees the room.

A little while later I walk into the den. George is intently watching an episode of Fairly Odd Parents (a cartoon about a little boy who has fairy godparents who grant his wishes with predictably disastrous results). I figured it would be a treasure trove of figurative language.

“So George,” I say. No answer. “George…George?” I step over to him and tap his shoulder. “George.” Nothing. I get between him and the TV screen. “George.” He leans over to look around me. I turn off the TV. “George,” I say. He blinks.

“Yes Tori?”

“Have you heard any idioms yet?”

“Any what?”

“Idioms, George. You’re supposed to be listening for idioms.”

“Oh. No,” he says. “Can you turn the TV back on?”

I did, deciding I would sit in the room and watch the rest of Fairly Odd Parents with him so I could call his attention to any random idiom use. Apparently, though, the writers of Fairly Odd Parents do not rely heavily on idiomatic expression. I heard nary a one.

So now I’m up a creek without an idiom. I tried reading through a few of George’s books but, alas, children’s chapter books are sadly devoid of colorful language. I even read through Calvin and Hobbes, but while the boy and his tiger have fun flights of fancy (and some surprisingly verbose tangents with serious multi-syllabic vocabulary), there are still few idioms to be found.

I thought about peppering my speech with figures of…well…speech, but I had visions of George fixating on why exactly I had put our cat in a bag. Or his little brother, Bennett, searching the closets for skeletons and getting really irritated when he didn’t find any. (He really likes skeletons, but that’s another story.)

We finally ended up getting the whole family involved in pointing out idioms. His mom, his teenage brother and I would try to catch them whenever we heard one and explain them if we could (some expressions have mysterious etymological origins). It became a game that has lasted long past the end of George’s original school assignment.

Most recently he learned “put the pedal to the metal” from a racing video game. One afternoon, he repeated it over and over until I asked if he knew what it meant. He didn’t, but seemed delighted in my explanation. “Oh,” he said, enlightenment dawning. “You mean like Daddy drives.” I winced and made a mental note to address that later. “Yes, honey. That’s right,” I said.

George continued to use his new idiom most of the day - loudly, enthusiastically, repeatedly. As much as I thought I was going to pop a vessel if I heard it again, I didn’t intervene. He was enjoying figurative language, I told myself. Don’t spoil it. So I didn’t. That is, until he instructed me, just as enthusiastically, to “put the petal to the metal” while I was making his dinner. I suggested he try another idiom.

“Like what?” he piped. I gave him one. He stared at me blankly for a moment and then, with a happy noise, he disappeared down the hallway and reappeared a moment later swinging his stuffed Tigger by its posterior appendage and chanting his new idiom at the top of his lungs. I sighed and turned back to my burning chicken. George might not have gotten my point, but he sure was having fun missing it.

BIO

Tori Gallagher lives in Asheville, North Carolina, with her partner, three sons, two dogs (who do fairly good impressions of a wolf and a big black sheep, respectively), one cat (who apparently thinks she’s a Rastafarian) and various imaginary friends (most of whom were created by the guys, George and his little brother, Bennett, who also lives on the spectrum). Look for more about George in future issues of the Digest.

Reprinted with permission from the

May-June 2006 issue of the Autism Asperger’s Digest.

www autismdigest.com

Compliments of the Autism Asperger’s Digest magazine

Column: SIMPLY GOOD IDEAS – January-February 2006 issue

Plan Today for Generalization Tomorrow

By David F. Freschi

Here we are, back from the long holiday break, half of the school year is over and the questions from teachers and parents of ASD kids are pouring in.

“Horace knows so many things but he can’t seem to generalize any of his knowledge – what can we do?”

“Suzie has mastered everything in her curriculum and on her IEP; we have the charts to prove it. But when we put her in a class with someone besides her 1:1 aide, she can’t answer any of the same questions or use the same skills.”

Another, more serious example is Mike. Mike has a “job” in school that involves sorting the teachers’ mail and placing it in the appropriate mailbox. The staff informed me that Mike was “doing great” on the job. As I observed Mike in action here’s what I saw: Mike did complete the job, but not in 45 minutes. More alarming was that in the first 15 minutes his 1:1 aide gave him 41 prompts! (We stopped counting at that point.) I then asked one of Mike’s peers to do the same job. He completed it in 15 minutes with 1 prompt. Has Mike ‘mastered’ the task of sorting the mail? Our response is no, nor would we label his performance as ‘great.’ This is an example of how poor generalization and prompt dependency can cause serious problems in real world settings.

It is always frustrating to parents and teachers to witness a student with ASD who supposedly “knows” a skill yet is unable to transfer that knowledge to other settings. If we think about it, maybe it’s we who are contributing to that inability because we are not teaching in a manner aligned with the autistic mind. Rigid thinking and an inability to generalize information are well-known and well-documented characteristics of autism spectrum disorders, and usually play off each other. Yet, we as teachers and parents often neglect to plan for generalization in our day-to-day teaching strategies. We get so wrapped up in individual skill mastery that we fail to envision and plan for how the skill will play out in the real world, outside the instructional setting. Instead, we teach students skills in very specific ways, where questions are presented exactly the same way over and over and in highly structured and controlled settings. The result? We may reinforce rigid thinking and rigid behavior. Often these students do learn to perform the skill, and we pride ourselves on the skill being ‘mastered.’ But is the student functional with the skill in natural settings? Probably not. Often without thinking, we confuse the process for the student by weaving into the skill lesson certain, unrelated components to the functionality of the skill, i.e. sit at your desk, fold your hands and follow the “look at me” prompt prior to demonstrating the skill. For example: 2+2 = 4 whether we are sitting at a desk with our hands folded and making eye contact, in the supermarket, or counting plates alone in the cafeteria. Maybe teachers should rethink some of those components, such as “look at me”, folded hands, sit at the desk, etc. if their end goal is an adult who can function appropriately across settings. How many times have ‘folded hands’ been part of a skill you use on a regular basis?

Many teachers seem to view ‘generalization’ as a skill in itself, to be taught at some point in the future, after other, more ‘important’ skills affecting behavior, or communication or social skills are taught. In reality, generalization is not a separate ‘skill’ – it’s a way of thinking, of relating bits and pieces to the whole picture, and it is this holistic viewpoint that we, as teachers and parents, need to incorporate into our teaching. It’s planning today for where these kids will be tomorrow, and teaching accordingly.

Let’s look at some strategies that might help your students or children. These are all ‘kid tested’ and have been successful with children with ASD we’ve worked with in the past.

1. First, start early and plan for generalization right from the beginning. It’s not something we should think about down the road, when some imaginary standard of competency is met. It is an intangible that we need to address from the start.

2. Planning in our heads, or incorporating generalization ‘off the cuff’ is not enough; we must incorporate ways to promote generalization so that is it a systematic part of our teaching plans. Remember: Kids with autism learn by doing.

3. Keep in mind that by actively incorporating elements that promote generalization, the skill mastery may take longer than if it was taught in a discrete trial format. Natural setting teaching asks that the child pay attention to the many components involved in the task at hand. Value the ability to generalize a skill more highly than one-setting skill mastery. In the long run, it will be of more benefit to the child. This not to say that discrete instruction is not valuable. It is one of our essential tools. We need to use it where it makes sense; introducing specific skills, building fluency etc. It is also worth remembering that a discrete trial can take place anywhere. Again, we don’t need the desk, the folded hands, and the specific language.

4. Any task/skill we’re teaching has various components; some of them are listed below. Consciously manipulating these components can help a student learn to generalize. Not all ideas will work with all kids and not all ideas should be implemented at once. Some of these suggestions will need to be modified to suit the child’s level of overall functioning. While teaching generalization is important and should be the environment in which you teach a particular skill or task, introducing elements that confuse the child can have a negative impact. If you know the child’s strengths and challenges well, you will be able to distinguish ‘growing pains’ from when you’re pushing into the disaster zone.

• People: The temptation is to use the child’s 1:1 aide or the behavior/ABA aide for everything. Unless those people plan on spending the rest of their lives with the student, this is a bad choice. Start switching people around gradually so the child gets used to responding, interacting, and working with more than one person; it’s much closer to the real world than is a desk in the corner. It also expands the knowledge base of several adults, which is not only good for the student but also for the next student with ASD who comes into the class. Try letting everyone on the IEP team know what skills the student is working on today or for the week. This includes the principal, the cafeteria lady, and the custodian. Imagine this scenario: four or five people throughout the day ask the student something about the skill he’s working on. This will go a long way towards generalizing the information and improving social skill at the same time.
• Place: While it is important to have a structured, personal “safe” place to work, it is equally – if not more - important that the child learn that information and knowledge is “portable.” Try doing that lesson in a new part of the room. Make a small change in the current arrangement of desk and chairs. Switch chairs with the child. Do a lesson in the hallway or the library or the cafeteria. Systematically put a little variation into the setting where you’re teaching.
• Location: Try to teach as much as possible in a real-world, natural setting for the skill. If this isn’t possible, try to recreate the real world setting within the classroom as much as possible.
• Language: Again, we want to put small variations into our requests and responses. Keep them concrete and clear but do vary them a little. If you find your student needing highly specific language to be able to answer a simple question then you probably need to rethink your teaching strategies a bit. It is unrealistic to expect that the real world or even the whole school is going to learn and use exact phrases. With very high-functioning students, keep a careful eye on adding language variations that may be confusing to the student. Idioms, metaphors and slang generally need to be specifically taught to ASD students.
• Materials: Materials and objects are the easiest variations that can help with generalization. I know, you spent lots of dollars for those cute little counting bears in your math program. Sorry; in the real world we count everything, the interesting to the mundane. If we get used to using a variety of materials, so will our students.

5. Encourage flexible thinking: Anything you can do that encourages a student with ASD to think in flexible ways will help their ability to generalize information. The two go hand in hand. Introduce planned surprises in the daily schedule, subtle changes in the child’s routine, etc. Reinforce to the child that learning is a step-by-step process, that everyone makes mistakes, that nobody is perfect, etc. Again, the real world is filled with daily disruptions that require that we make adaptations to our plans. It is important that we help our students learn to tolerate and handle these little stressors in life now, not view that as another ‘skill’ to be learned ‘later.’

6. Check your behavior: It is important to watch your own behavior. If you see yourself getting into rigid behavior, teaching or even thought patterns, plan a change or variation in how you do things. Watch out for placing too much emphasis on skill mastery, to the exclusion of context. Count the number of prompts you use to help a student complete a task. Compare that with how many prompts a typical student would require. If necessary observe a typical student doing the same task to develop your target goal. Remember: prompts are something that you add to a lesson. It is your job to systematically fade prompts and not leave the student dependent upon them. Consider that ‘prompts’ are not just your words: all the components of a task, the people, setting, location, materials, act as prompts and can inhibit or enhance generalization, depending on how they’re used. Finally, if you find that you have taught a lesson that can only be done under rigid circumstances in the 1:1 room, please don’t be telling little Suzie’s parents that she knows a skill. Suzy and her parents deserve better.

In closing, it behooves those of us who live with, work with or teach individuals with ASD to keep in mind that generalization is not going to happen automatically as it does with other students. The key is systematically inserting variations in the components of the skill at a level that doesn’t overstress the student but does force a little bit of change. Don’t plan to work on generalization sometime in the future. Plan to incorporate it into your teaching strategies now. After all, our goal is helping children grow to be educated and functional human beings in all settings, not just the classroom.

BIO

David F. Freschi operates Simply Good Ideas, a nationwide consultation and training service for school districts and organizations, with an emphasis on practical solutions that work. He has more than 30 years successful experience with children and adults with ASD. Visit his website at www.sgideas.com

Reprinted with permission from the

January-February 2006 issue of the Autism Asperger’s Digest.

www autismdigest.com

Compliments of Autism Asperger’s Digest magazine

Column: ASK THE EXPERTS – Nov-Dec 2005 issue

Adapted Physical Education

By Sarah Spella, Adapted PE Teacher

Q:

We have several children with autism/Aspergers in our school system, and a couple of them are struggling with motor issues and social involvement, especially in PE classes. Can ‘adapted physical education’ help them? What’s it all about?

A:

Adapted Physical Education (APE) is a special education service provided for those special needs students who require adaptations and modifications in curriculum and/or equipment in order to participate with their peers in PE. This service is also provided to those students who do not process visual, audio or touch cues at the same rate as general education students, or who have perceptual motor delays or difficulties.

Who provides APE services and how does it start?

APE services are provided by an APE Teacher who provides direct service and/or consultation to the general PE teacher as well as the classroom teacher and paraprofessionals. The process is initiated when an APE Teacher receives a request to “observe” a student who may be exhibiting delays. The request may come from the General PE teacher and/or the school’s screening committee. The APE Teacher begins by having both the classroom and PE teachers complete the Adapted PE screening tool, a series of questions regarding how the student functions in the school environment as well as in PE. If it is determined further assessment of the child is needed, parental permission is sought. When given, the APE Teacher will go out to the school and conduct the Test of Gross Motor Development on the child. This test consists of a series of movement requests which allow the APE teacher to gauge the student’s use of different equipment, as well as their perceptual motor skills, balance and directionality. Once the evaluation is completed and analyzed, the special education team meets with parents to discuss the assessment results and options for service, which are then written into the IEP (Individualized Education Program) based on areas of need identified from the assessment.

Why consider APE for a child with ASD?

As a service, APE does more for a child than merely help with motor skill impairments. Many students with ASD have motor challenges. Their reactions may be slow, eye-hand coordination may be difficult, they may walk on tip-toe, be clumsy, or unable to complete bilateral movements. Some ASD students have good motor skills, however, their ability to process the sensory cues that arise from visual/verbal/tactile experiences, and that are linked to musculoskeletal action, is interrupted at some point, resulting in a physical reaction that may be different than that of their typical peers. Furthermore, many students with ASD have auditory issues that are amplified within a gymnasium, which may manifest itself in increased self-stimulation as well as covering of the ears, humming, moaning or running off task. All of these factors can inhibit a child from being successful in PE. These children quickly notice the social stigma that surrounds them because of their motor and/or social challenges. APE can help change all that.

I like to think that APE opens doors for autistic students who otherwise would not receive these types of services. On a professional level, I see the benefits of socialization with their peers, the benefits that regular movement brings in centering and stabilizing their behaviors. I see successes in school – in PE and also in academic areas - arising from an increase in self-esteem. APE is a fun and motivating experience that allows students with ASD to safely venture “outside their box” and experience the world of movement in a comfortable place and at a comfortable pace.

Are there a range of APE services?

Yes. Each student’s individual needs should drive their program. Services range from direct instruction on a 1:1 basis in a structured setting to participation in the general PE class with only consultative support. Children who do well in this type of inclusive setting are usually middle- and high school students who have previously received 1:1 APE services during the primary school years. A student progresses through the different service levels, from 1) direct service to 2) consultation with observation to 3) consultation, then to 4) being dismissed from APE services. At the final stage the student is performing on par with his or her peers.

Initially, Adapted PE may increase sensory issues because of the nature of the class; it can be noisy with objects flying around the child and there’s generally many students moving at the same time. However, I also believe it compels the student to deal with these sensory issues and find independent ways to confront them so he can continue to participate with his peers. We often work closely with the child’s Occupational Therapist on sensory issues to create environments with the highest opportunity for success for the child.

I have students with autism or Aspergers at the high school level who do remain in 1:1 structured APE settings, either receiving individual support or working with a few other classmates in a small group setting. Again, a range of factors regarding the nature of their autism and their learning style needs to be taken into consideration in program planning.

Are APE services covered under IDEA/Section 504?

APE services are covered under sections of PL-94-142 of the IDEA that state that all children should receive a free, equal and accessible public education. APE falls under the “accessible” part of the legislation. If a student is not safe, is not able to communicate, has motor concerns, is in a wheelchair, has behavioral issues or is otherwise unable to participate at the same level as his peers, then his or her access to the PE program is limited. Through APE services, that accessibility is made possible.

Examples of Goals/Objectives for APE:

Elementary level:

Johnny will catch a ball using arm extension and scoop from a distance of 5 feet, three out of five trials successfully.

Middle School:

Johnny will participate in offense and defense play with peers and be able to recite three game rules at the end of the unit.

High School:

Johnny will increase his core strength to improve postural control by performing: 60 sit-ups (broken into four sets of 15), prone extension three times for 20 seconds; and V-sit hold three times for 10 seconds.

Perception affects Performance

I have been working in the APE field since 1987, and I believe that students with ASD know when teachers believe in them, in their ability to learn and become more physically and socially able. They have a sense of our attitudes, whether we view them as “I know you can do it” or “This is a waste of my time and yours; this kid is never gonna get this.” More than anything else, I believe this one factor is key to their success in learning to play a game, maneuver an obstacle course, ride a bike, or swim the length of the pool. When we, as teachers, approach students with ASD with a Can-Do attitude and support them with positive feedback and positive reinforcement, we will see more success in not only PE, but in all areas of their lives.

Ù

For more information & ideas on APE Sarah recommends:

Games For People With Sensory Impairments by Lauren J. Lieberman & Jim F. Cowart

Strategies for including individuals of all ages.

A Teacher’s Guide To Including Students With Disabilities In Regular Physical Education, Second Edition by Martin E. Block, Ph.D. (Brookes Publishing Company)

Ideas for adaptations in motor skills: www.pecentral.com

APE info/links from Portland SD: http://www.pps.k12.or.us/depts/speced/mdt/mdt.shtml

BIO

Sarah Spella graduated from University of Wisconsin-Stevens Point in 1987 with a BS in Physical Education K-12 and Adapted Physical Education K-12. Since then she has been teaching in public school systems; for the last 8 years in Portland. She has also been Coordinator for the school district’s Special Olympics Partnership for 7 years. Sarah and her husband Dean have a 3 year old son, Nino Joseph, 3 dogs, 5 cats, a Chinese water dragon, hermit crab and betta fish. In her spare time, Sarah teaches Spin and strengthening classes. Contact her at sspella@pps.k12.or.us

APE in Action!

*Chase is a 5 year-old boy diagnosed with ASD/MR who receives APE services. Prior to coming to the APE setting, Chase is provided with a Social Story that describes the day’s lesson in a story format and prepares him for the experience. Once in the setting, pictures (icons) provide a step-by-step guide of the activity and the expectations for his involvement that day. An example:

Chase will enter the Gym with peers and find his spot on the floor (picture of Chase on his spot in the gym). Chase will run with his peers 4 times around the gym on the black line (picture of Chase with aide and peer hand in hand running on the black line). Chase will return to his spot for stretching and floor exercises (picture of Chase on his spot doing stretches, sit ups and tummy push ups). Chase will join group for catching and throwing to a partner (picture of aide and peer with a ball).

We found that Chase needed the 3-step process: seeing what is expected of him (visual cards), hearing what is expected of him (story dialogue) and then actually doing the activity (”feeling” the experience). The social story, usually on a small square piece of laminated cardboard, with velcro patches to attach and remove pictures) accompanies Chase and is shown when he needs to return to on-task behavior.

Chase has a 1:1 aide who accompanies him to inclusive classes, and provides direct hand on hand contact with Chase as instructions are given. At present Chase is able to stand on a spot, recognize his name on the spot and remain on task when given 1:1 direction. He is provided with a “toy” (usually a manipulative ball or a bite stick around his neck) to calm him when self-stimulative behavior escalates. He is learning to communicate the word “out” when he needs time away from the group. In those instances, Chase’s aide and a peer move away from the group, still within the PE setting, and work 1:1 on class skills.

Every 9 weeks, progress reports are sent home, goals are modified as needed and at-home activities are updated. When school is out for the summer, we provide a comprehensive list of local organizations along with suggested skills for Chase, his teacher/instructor and his parents to follow.

(*name has been changed)

Reprinted with permission from the

November-December 2005 issue of the Autism Asperger’s Digest.

www autismdigest.com

Compliments of the Autism Asperger’s Digest magazine

Social Skills Slump?

Motivating the Desire to Learn

by Jed Baker, Ph.D.

John is 3 years old, with very limited language skills. When his parents try to sit and play with him he focuses on lining up play letters on the floor, virtually ignoring his parents. They call his name and he does not respond. They show him other toys and he ignores them. His older sister tries to engage him in a game of peek-a-boo and he shows no interest.

Karen is 12 years old with Aspergers Syndrome. Her intellectual and language skills are excellent; she is very articulate and understands most anything someone says to her. Often, when she has a project in school, she either refuses to do it or refuses to compromise with peers or teachers on how to do the project. Her teachers and parents explain to Karen that she needs to compromise if she wants to develop friendships with peers and that she needs to do the school work if she wants to graduate and get a job later in life. She explains that she has no interest in making friends or ever having a job, and thus there is no need to do the work or compromise with others.

Although very different in their levels of functioning, both John and Karen are not motivated to learn social skills. Efforts to teach them how to relate to others will be frustrating for their parents and teachers until the issue of motivation is addressed. The table below summarizes some methods of motivating students to learn social skills and many other skills.

LOCUS OF MOTIVATION

For learning Social Skills

EXTERNAL/CONTRIVED INTERNAL/NATURALISTIC

Preverbal reasoner	Controlled studies demonstrate effectiveness Discrete Trial Intervention – Lovaas (Rewards are not necessarily logically related to the student response)	Controlled studies demonstrate effectiveness Verbal Behavior Training – Sundberg and Parrington Natural Language Paradigm & Pivotal response Training- Koegel & Koegel (Rewards are logically related to the students response) Promising but no true controlled outcome studies yet · DIR/Floortime- Greenspan RDI - Gutstein
Verbal reasoner	Controlled studies demonstrate effectiveness Token systems Behavior charts	Promising but no true controlled outcome studies yet Link skill goals to student’s personal goals Increase awareness of assets before describing possible challenges that need to be addressed Make socializing fun Have student teach others the social skills

The Table categorizes different methods of motivating students in terms of the language ability of the students (preverbal versus verbal reasoner) and the locus of motivation (external/contrived versus internal/naturalistic). Preverbal reasoners are students who may have some language but are not yet able to understand If–Then statements (e.g., “If you play this with me, then you can have a snack.”). Verbal reasoners can understand If–Then statements and thus could respond to the use of verbal reasoning as a motivational method (e.g., “If you do your math with me, then we can play afterwards.”).

External/contrived motivation refers to providing students with a reward that may be unrelated to the activity or response they are making. For example, if a student is able to greet others when prompted, an external reward might be a special snack or access to a toy. The reward here is not logically related to the response (i.e., greeting) and is not naturally built into the situation (i.e., the instructor must provide the reinforcement). Internal motivation refers to situations in which the student’s behaviors naturally provide them with rewards because the activity itself is rewarding or the student’s response brings its own rewards. For example, if a child enjoys playing follow the leader, then playing the game is itself rewarding and there is no need to provide another reward. Similarly, if a student learns to request a toy from others and receives the toy, then the request naturally leads to its own reward, receiving the toy.

Motivational Strategies for Non-verbal Reasoners

The methods listed for non-verbal reasoners are those strategies often associated with “early intervention.” The goals are often to build crucial skills that are prerequisites for later learning in school and social settings. These skills include: joint attention (attending to others and attending to what others point out), the ability to label objects, request objects, follow simple directions, and answer simple questions. The interventions associated with applied behavior analysis (ABA) have been subjected to the most rigorous controlled evaluations of outcome and demonstrate excellent results in about 50% of autistic students in terms of intellectual, language, adaptive and early social skills.

ABA approaches include Discrete Trial Intervention (DTI) (Lovaas, 2003), Natural Language Paradigm (and its more recent cousin Pivotal Response Training; Koegel & Koegel, 2005), and Verbal Behavior Training (Sundberg and Parrington, 1998). Although all these approaches share a basic structure of teaching behavior through cueing, prompting and rewarding students, they differ in their emphasis on teaching in natural environments, and utilizing internal/naturalistic versus external/contrived motivational systems.

A discrete trial has five components: a cue, prompt, the student’s response, a reward and data collection. Early DTI interventions often emphasized compliance and labeling of objects. For example, if a child was learning colors, the child might get a cue, “Point to the blue car.” Then the instructor might prompt the student to touch the blue car. If the child responded correctly he might then get a favored reward, such as a piece of candy. Here the reward is not naturally related to the response. Earlier DTI approaches have been shown effective in improving students’ ability to respond to adult cues, but not always as successful in increasing students’ spontaneous language or generalizing skills to natural settings.

In contrast, Verbal Behavior Training and Pivotal Response Training occur in more natural settings and capitalize more on the students’ own interests. In the first phase of verbal behavior training, the emphasis is on teaching children to spontaneously request, utilizing the students’ own interest in activities, food, objects, wanting a break or wanting attention while in a more natural play environment. As such, the students are typically highly motivated as their responses lead to naturally rewarding consequences (i.e., getting what they requested). Similarly, Pivotal Response Training begins with assessing what the student is interested in and then beginning a discrete trial centered on that interest. For example, if a youngster shows an interest in playing with a car, the adult might hold the car out and cue “What color is the car?” If the youngster says “car”, the adult might cue and prompt, “What color is the car? Is it blue?” And when the child says “blue car”, the child would get to play with the car.

Greenspan’s “Floortime” approach, one segment of his DIR (Developmental, Individual-Difference, Relationship-Based) model, also capitalizes on the student’s own interests. It emphasizes following the lead of the youngster as the adult plays with the student in an effort to target various developmental skills (Greenspan & Wieder, 1998). Although there are some semi-structured play activities in this model, cues, prompts and rewards are not used in the same systematic way as in ABA methods.

Another promising approach is Relational Development Intervention (RDI) (Gutstein & Sheely, 2002). RDI outlines a systematic set of activities that create opportunities for “shared experiences.” At the heart of RDI is motivating the child to feel the intrinsic delight in connecting to another human being, so that they want to engage in social interaction because of the joy in the activity - not because of a contrived/external reward for interacting. Early activities to build joint attention might include imitation games like follow the leader, or “follow my eyes to the prize,” where students have to look at an adult’s eyes to find where the adult hid a prize in the room (the adult is looking in the direction of where the prize is hidden). Although these activities have not yet been empirically tested, the concepts behind RDI are reasonable: engage students in activities that limit over-stimulation. require attending to others as part of the instructional format, and teach children to look to other people as information sources to understand the world around them.

Motivational Strategies for Verbal Reasoners

Verbal reasoners understand If – Then statements. For example, “if you learn how to stand in line, you can order your favorite hamburger at McDonalds” or “if you learn good interview skills for a job, you might get that job you want.” External motivational strategies that have proven effective in helping verbal reasoners involve finding meaningful incentives (rewards, privileges) for practicing new skills.

Token or point systems are examples of external motivational strategies. Here a child earns a token or point each time he exhibits the appropriate behavior being learned. A pre-determined number of points or tokens can be exchanged for short and long-term rewards. Note: as with pre-verbal learners, the reward is not necessarily logically related to the behavior. For instance, a child may agree to practice ‘sharing skills’ in order to earn time to play computer video games by himself. Each token provides a measure of motivation in itself. Furthermore, points or token are usually kept track of on a visual behavior chart, which provides further motivation. Token systems can be used with young children to learn simple skills. They are equally effective in teaching a child delayed gratification and using a combination of skills to achieve a social behavior goal.

While language abilities can often be highly functional in this segment of the autism population, parents and teachers should recognize that often the child’s perspective-taking abilities will not be on par with their language skills, and should be taken into account when choosing motivational strategies to use in teaching social skills. A verbal reasoner may still need very basic external motivators in learning certain skills. Mix and match as is appropriate.

For many verbal reasoners, however, external/contrived rewards are not necessary, and internal/naturalistic motivational strategies that are closely aligned with their goals and desires work well. These are sometimes the children who feel a strong desire to connect with their peers, but lack the ‘how to’ component of social adeptness. Josh often was eager to play with his elementary school peers, so eager that he would barge right into their play group in a disruptive manner. It was obvious he wanted to join his classmates in their activity. He just lacked the social know-how to approach them appropriately and ask if he could play. If students want friends, good grades, a job, or to be able to engage in an activity (sports, clubs, or a social event), then linking social skills lessons to these goals is an effective motivation in developing the crucial skills needed. However, what do we do for the student like Karen who wants no friends, no job and seems to have no goals? Anxiety, depression and withdrawing from the social world entirely are common reactions to the tremendous efforts often required of our kids. Their impaired social understanding and limited perspective-taking usually result in more social failures than social successes… none of us enjoy that experience Such students may need to deny any need for skills training. It takes a modicum of self-esteem to tolerate thinking about what one’s difficulties one has. One way around such resistance is through counseling that allows them to expand their sense of their talents and strengths before targeting areas that need improvement. For most students, it is helpful to have someone else point out two to three strengths for every difficulty that is highlighted. The student can be asked directly what talents and strengths they have and then the counselor can add or refine that lists of strengths before suggesting areas in need of improvement. For example, during group sessions, I will ask each member to talk about their special talents and I corroborate these positive descriptions. Then I might say “There are some minor issues I want to address with you guys so you can continue to do as well as you are doing now.” Keep it positive; keep it honest, but keep it light, too. No one wants to feel they need to be constantly ‘fixed’.

Another method involves having students create picture books (see discussion below), videos or live skits, so that they can demonstrate the skills to other students. As such, they can learn a skill in order to “help others” without having to acknowledge that they themselves needed to learn it.

Skill Lessons

Skill lessons include a variety of strategies geared to the student’s cognitive/language functioning. For verbal reasoners we might break down a skill into its component steps, explain it, model it, and role-play it until the youngster can demonstrate the skill and understands why it is important. Marty is a student with good verbal skills, however he always wants to do things his way. His behavior gets in the way of developing peer relations. We decide to teach Marty how and why to compromise. We teach him how to ask what others want, say what he wants, and to offer to do a little of both. We explain that when you do a little of both (i.e., compromise) the other person will be happy and may want to play with you again or be your friend. Using this straight-forward approach, we have broken down into simple steps over 70 such social skills related to play, conversation, emotion management and empathy in a manual on social skills training for children with social-communication problems (see Baker, 2003).

For very young students (3 and under) with very little language or ability to attend to others, we might begin with one of the early intervention strategies previously described (Discrete Trial Intervention, Verbal Behavior Training, Pivotal Response Training, Floortime, or RDI). For students who have developed some language but still have difficulty understanding verbal explanations, I have translated a subset of the skills that appear in the manual (Baker, 2003) into picture form (see the Social Skills Picture Book, Baker, 2001). Instead of explaining skill steps with words, they are illustrated through a picture sequence. For a skill like compromising, the pictures demonstrate a student asking to play a game with another youngster who says he wants to play another game. We show them pictures of the students compromising and playing a little of both games with both looking happy. Then we show them pictures of the same people not compromising, not playing with each other and both looking upset. Making your own picture books comprised of pictures of your child or student engaged in the right (or wrong) way to demonstrate the skill is especially motivating.

Timing and Perspective

Many adolescents who never wanted to learn social skills while in elementary school suddenly find themselves strongly motivated to learn certain skills in an effort to help them find a date. While some motivation is better than no motivation, parents and teachers do children with ASDs a grave error by ‘waiting’ until some intrinsic form of motivation appears before making social skills training a priority.

Social skills are a function of everyday life at all ages, and as such, priority should be given to teaching social skills in a structured manner from a young age. Certain social skills form a foundation without which children will remain alienated from developing meaningful relationships with others. These include skills like sharing, social conversation skills, good manners/etiquette, learning to ask for help, accepting ‘no’ for an answer, compromising, asking someone to play/join in a group, accepting mistakes and moving on, etc. These global skills are needed in early life in developing friends and surviving in school and in later life in the workplace and forming meaningful personal relationships. These ‘social functioning skills’ should not be overlooked in the desire to teach ‘social relatedness.’

At a younger age, parents can use external motivation strategies to teach children mastery of the core social functioning skills, especially if the skills are taught in a fun manner. As children move into elementary school, as much as possible begin weaving more naturalistic motivational strategies into the mix, as these also reinforce cause-and-effect concept formation in the child.

Generalizing Skills into Real Life

Keep in mind that no matter what the motivational strategy used, repeated practice of emerging social skills in “real situations” is necessary. In order to practice the new skills, students need opportunities – and lots of them. Facilitated opportunities involve creating daily situations in which the skills can be practiced and coached. Sometimes these opportunities are naturally built into the day. For example, a student learning to deal with frustrating work may already have his or her share of challenging work to do during the day. Other times the practice opportunities need to be carefully planned or orchestrated. For example, a student who never initiates conversation with anyone may be asked to call someone on the phone once per day or join others for lunch and initiate conversation once during that period.

If it is necessary to use external motivators, it is important to conduct a rewards/ reinforcement assessment periodically to maintain motivation in children with ASD. We recommend about once a month, especially when using external motivators. A child’s interests change over time; rewards must too.

Lastly, keep in mind that it is possible to understand many new skills quite rapidly, but to actually use skills in real life, it is necessary to limit the number of skills targeted to two or three themes over several months. Focusing on fewer skills intensely (e.g., through daily activities) for several months leads to better generalization than targeting too many skills in a short period of time.

Ù

Teaching children with ASD social skills and social relatedness is paramount in assuring they grow up with the ability to be functioning and contributing members of society. Using a variety of motivational strategies (both meaningful external and intrinsic rewards) and creating frequent opportunities to practice are key factors in achieving success.

BIO

Jed Baker, Ph.D., is the director of the Social Skills Training Project in Maplewood, N.J., and a behavioral consultant for several New Jersey school systems, where he provides social skills training for students with Pervasive Developmental Disorders and learning disabilities. He lectures nationally on social skills topics, and is the author of The Social Skills Picture Book (2001, Future Horizons) and Social Skills Training For Children and Adolescents with Asperger Syndrome and Social-Communication Problems (2003, Autism Asperger Publishing Company). For more information about Jed Baker and the Social Skills Training Project, visit www.socialskillstrainingproject.com.

References

Baker, J. E. (2001). Social skill picture books. Arlington, TX: Future Horizons, Inc.

Baker, J. E. (2003). Social skills training for students with Aspergers syndrome and related social communication disorders. Shawnee Mission, Kansas: Autism Aspergers Publishing Company.

Baker, J.E. (In press). Social skills training for the transition from high school to adult life. Arlington, TX: Future Horizons, Inc.

Baker, J.E. (In press). Social skill picture book for teens and adults. Arlington, TX: Future Horizons, Inc.

Greenspan, S. I. and Wieder, S., (1998). The child with special needs: Encouraging intellectual and emotional growth. Addison-Wesley, Reading, MA

Gutstein, S. E. & Sheely, R. K. (2002). Relationship development intervention with children, adolescents and adults: Social and emotional development activities for asperger syndrome, autism, PDD, and NLD. London: Jessica Kingsley Publishers Ltd.

Koegel, R. L., & Koegel, L.K. (Eds.) (2005). Pivotal response treatments for autism:
Communication, social, and academic development. Brookes Publishing Co., Inc.

Lovaas, O.I. (2003) Teaching Individuals with Developmental Delays: Basic Intervention Techniques. PRO-ED, Inc., Austin, Texas

Sundberg, M.L. and Parrington, J. W. (1998). Teaching language to children with autism or other developmental disabilities. Behavioral Analysts, Inc.

Reprinted with permission from the

September-October 2005 issue of the Autism Asperger’s Digest.

www autismdigest.com

Compliments of the Autism Asperger’s Digest magazine

Boosting Self-Esteem in the Autism Spectrum Child

by Cathi Cohen, L.C.S.W.

Dear Cathi,

My daughter, Emily, is an eight-year-old second grader who was recently diagnosed with Asperger’s Syndrome (AS). I’ve always known that Emily is a unique little girl, but I had no idea she might be on the spectrum. I was thrilled that Emily was reading by age four, but curious that she only read material about “bees.” She has virtually no interest in making friends and prefers to stay at home on the computer or with her face in a book (about bees, of course!). When my husband and I learned of her diagnosis, we wasted no time in researching local services for Emily and have already signed her up for pragmatic speech therapy, social skills training, occupational therapy, and after-school tutoring. We both feel very strongly that the more we can give Emily in the way of services, the more quickly Emily will develop socially, emotionally, and intellectually. However, we are concerned that all of this outside therapy will negatively impact Emily’s self-esteem . We don’t want Emily to think that we bring her to all of these appointments because there is something ‘wrong’ with her. We want her to know that we love her just the way she is. How can we help her understand that we’re trying to give her tools so she can succeed and be happy in life, and in the process develop a positive sense of herself as she develops and grows?

Sincerely,

Emily’s Concerned Parents

Dear Concerned Parents,

Being a parent is an enormous responsibility. Being the parent of an Asperger’s child is not only an enormous responsibility, but also one that requires you to develop a whole new set of parenting strategies and techniques that will, in all honesty, feel unfamiliar to you at first. The old tried and true methods that were so successful with neurotypical siblings need to be replaced with a new set of parenting skills based on an understanding of and respect for the very different thinking patterns, perspectives and learning styles that are part and parcel of the Asperger’s child.

Receiving the unexpected news that Emily has AS must have been difficult for you and your husband to hear. Although I know your impulse is to jump right into action in an effort to get Emily the help she needs, I caution you against moving too quickly. You and your husband deserve the time and emotional reserve to allow this information to sink in, and, perhaps, to mourn the loss of the child you may have thought you had. Before you embark on the journey to help her, it’s important for you first to accept your child’s unique qualities and let go of any unrealistic expectations you may have of her. This doesn’t mean you discontinue all outside services in an effort to “accept her for who she is,” but it may mean that you reevaluate how many services you provide her at one time. I often tell parents that the shotgun approach to professional help is not going to help a child progress faster. On the contrary, running around to service providers may be stressful to both you and your child. This is counterproductive to her growth process. Take some time to prioritize and limit Emily’s after school appointments. For instance, you may want to begin with pragmatic speech work and then add a social skills training component after Emily shows increased communication competence. This will give her a better chance of connecting with her peers in the social environment.

Much research has been published in recent years stressing the importance of high self-esteem to a child’s emotional and social development. Check out your local bookstore and you’ll find many books on this topic. You, like most loving parents, know how important self-esteem is to Emily, but you may be less clear on what you can do to help her feel good about herself. As a therapist who has been running social skills training groups with children for over fifteen years, my orientation is biased toward group work with children on the spectrum. Social skills groups for children with AS can be challenging but also extremely rewarding on so many different levels. For many children, a social skills group may be the first place they’ve ever felt safe and understood by peers. Parents of these children bemoan their child’s years of hardship with peers. They describe their children as socially isolated and ignored at best. Sometimes, these children are socially abused and ridiculed at school and in extracurricular settings. The children may be aware of being “different” from their classmates, but helpless to make the changes necessary to lead a satisfying social life. These social experiences affect their self-esteem dramatically. Likewise, a safe group experience can boost a child’s self-esteem almost immediately. When children experience social competence, they show more confidence in arenas outside the therapeutic environment. With their newfound self-esteem, children begin to take risks with peers they would not have previously attempted. Prior to a group experience, one group member sat alone at lunch. After participating in a group for a short time, she began to sit at a table with other children.

Emily is only eight now, but she may become increasingly aware of her differences from others over the next few years. Girls with AS are especially vulnerable to feeling left out. The negative experiences Emily has with others may put her at risk for low self-esteem, which causes children on the spectrum to isolate further from the world. A social skills group will allow her to express feelings and idiosyncratic ideas freely without judgment from her peers. Because similarity and common interests are essential hallmarks of friendship, she will begin to acquire the necessary competencies to develop true friendships. Together, group members experience a profound feeling of being understood. This feeling, in my experience, translates to increased comfort in the world. The boost in self-esteem creates a productive cycle where learning can take place and skills can be practiced.

As a parent, you cannot control the complex temperament and singular qualities that Emily was born with, but you can make sure that you create an atmosphere at home, with peers, and in your family life where she can flourish. The following steps will help you create a safe and nurturing environment in which Emily can develop high self-esteem. Remember: you know Emily better than anyone. Keep your knowledge of her in mind when you practice these techniques.

Step One: Help Emily Build Relationships with Peers

Improved peer relationships lead directly to high self-esteem, and it is never too early to focus energy on helping Emily develop friendships. She may not be interested in her peers now, but as she moves into adolescence, she will be. You will want her to have basic social interaction skills under her belt before she hits adolescence when peer pressures increase exponentially. Be clear that what we are talking about here is acquiring social skills, not emotional relatedness. They are very different aspects of social interaction. Emily needs to know the social ‘niceties’ – saying ‘please’ and ‘thank you’, not interrupting or being a ‘space invader’, sharing, turn taking, etc. These social skills allow a child to gain entry into social relationships. Emotional relatedness, on the other hand, is that intangible sense of connectedness that is hard to define and even harder to teach. Concentrate on social skills for now.

In addition, it is important to help Emily build appropriate social networks early on so that later she makes good social choices. Begin by setting up play dates for her. Emily may not be able to play with peers for several hours. It’s too much time for her to negotiate the complicated interactions of play and/or communication. Keep the play dates short, perhaps just 20 minutes at first, focused on an activity that interests everyone involved. If you are worried about peer rejection, asking a friend to an enticing activity lessens the likelihood that rejection will take place. Set limits on the time Emily can spend playing computer/video games by herself so she has some time for “free play.” Prior to a play date, you may want to review the social rules. For instance, remind Emily that the guest gets to choose what she wants to play with and that the topic of bees, for example, is off limits for the play date. Remove all toys that Emily does not want to share prior to the play date. If she is made aware of behavioral expectations in advance of the situation, Emily will feel more a part of the decision-making process, which in itself is self-esteem building.

Step Two: Encourage Areas of Competence (To a Point)

A child with AS may develop a particular area of interest to the exclusion of others. The indulgence in Emily’s fascination with bees, for instance, offers her enjoyment, a sense of mastery, and a topic to talk about with peers and adults. In addition, the topic may help her manage social anxiety she feels around peers. The problem for many families of children with AS is that the expertise comes at a cost. You may be happy that Emily has found an area that helps her feel like an expert, but it may drive you crazy to have to listen to her talk about the topic incessantly. Rather than cutting her off from her interest entirely, start setting some boundaries that limit the time she spends on the subject of bees. Timers can be helpful in signaling the end of an activity and the beginning of another one and visual tools like this are highly effective with AS children. You may want to create a secret code word or gesture with your child that inconspicuously alerts her to change the subject. While Emily is getting used to these limits, make sure you set the stage for success by offering her another enjoyable activity she feels comfortable and confident performing before you set the timer.

Step Three: Promote Physical Activity and Healthy Nutrition

Regardless of Emily’s particular area of competence, physical activity should be part of her normal daily regime. Like many children with AS, Emily may have motor skill challenges that result in her avoiding activities that involve a ball, running, or that require balance such as riding a bike. You may need to be creative in discovering physical activities she enjoys. Our group members have enjoyed horseback riding, martial arts, jumping on a trampoline, or swimming. Do not give her a choice about this issue. She may choose the activity, but her participation is mandatory. In addition, make sure she eats a balanced, healthy diet. Making healthy life choices translates into high self-esteem.

Step Four: Use Praise and Discipline Effectively

Understanding Emily’s newly diagnosed condition does not mean that you do away with appropriate discipline. The operative word is ‘appropriate.’ Continue to set clear limits with Emily. Make sure when you give her a direction that a) she understands how to comply (check for comprehension) and b) you mean it. Say the command clearly and firmly, and impose an immediate consequence if the command is not followed. For instance, you may say, “You are dressed for school. Now, you must brush your hair.” If the direction is not followed, say, “You have not done what I asked. For each minute I wait for you to brush your hair, you will lose a minute of screen time this afternoon.” Praise needs to be immediate as well. Be specific – and honest - with your praise. For instance, “Emily, I like that you immediately went to your room to brush your hair when I asked you.” Kids know when you’re being insincere with praise, so do be genuine.

Step Five: Help Your Child Learn From Mistakes

Children with low self-esteem are terribly afraid of making mistakes, and this fear makes it very difficult for them to take chances. This is especially true for a child with autism. One mistake is just as enormous as the next in the mind of the spectrum child. Lacking the ability to see themselves through others’ eyes heightens the struggle to differentiate between small and large mistakes. If Emily sees all of her mistakes as HUGE, she may choose to retreat into her own world rather than face possible failure outside of it. You can help her get over her fear of failure, but it will take time and patience. Make sure that you react calmly to your own mistakes as well as hers. Show her alternative behaviors that make amends for the mistakes that she makes. Continue to encourage her to take risks and praise her efforts to do so.

Step Six: Encourage Positive Self-Talk

When Emily is experiencing an emotional situation, the thoughts that go through her head can be either helpful by urging her forward, or hurtful by holding her back. A child who says negative things to herself is not going to soothe herself; rather, her words will stir her to new heights of anger or depression. Openly communication with Emily about various feelings she may be experiencing and the self-talk associated with those feelings. Give her new language to soothe herself in difficult times. Instead of “I hate myself” or “I can’t do this,” help her think and say, “I’m mad but I can handle this.” Or “I can do this.”

Ù

Finding opportunities to boost Emily’s self-esteem will be an ongoing activity for you and your husband. Remember: Emily is a child first. She came into the world with a unique temperament all her own. In addition to who she is as a person, Emily also has a condition called Asperger’s Syndrome. It affects how she perceives her world, but it is not the sum total of who she is. Her personality is constantly interacting with outside forces. Teachers, grandparents, peers, and siblings all affect her self-esteem. As a parent, you cannot completely control who interacts with Emily or how her self-esteem will ultimately develop, but you can create a safe, nurturing home where Emily’s uniqueness can unfold. You may find yourselves feeling simultaneously discouraged, frustrated, hopeful, challenged, and enlightened with her growth and development. Emily will show you over time her unique talents and abilities. It is clear from your letter that you love Emily. By appreciating and validating who she is and helping her achieve her goals, you insure Emily’s happiness and healthy self-esteem.

BIO

Cathi Cohen, a licensed clinical social worker and certified group psychotherapist, is a leading expert in the field of social skills training. Her book, Raise Your Child’s Social IQ - Stepping Stones for People Skills for Kids, is based on the many years of collected data and experience of Stepping Stones, a social skills training program for children and their parents, which Cohen created in 1990. Cohen is the founder of In Step, a private program that offers an intensive social skills training program especially geared toward children on the spectrum. For more information visit www.insteppc.com or email instep@erols.com.

Reprinted with permission from the

March-April 2006 issue of the Autism Asperger’s Digest.

www autismdigest.com