Expert: Dr. Sharon A. Mitchell - 8/12/2009

Question
QUESTION: My daughter is 3 years old and has autims. She will be starting her first day of preschool tomorrow. From the school orientation I am not sure if this school is going to be the right fit for her. We live in a small rural town in Oklahoma and they do not know much about autism. I feel that we should move but have know idea where the best schools are. Do you have any recomendations? And what should I be looking for in this preschool? The teacher  wants to treat her like the other children, but sometimes that is impossible I don't believe she grasp that sometimes Emma just can't do things like the other kids. I have a constant war with myself. I am not sure if I am being paranoid because it is her first day of preschool or if I am just having a hard time letting her go.

Thanks for any help you can provide

ANSWER: Any mom would be worrying about her child's first day of school but this is especially hard when your child has autism.

I'm afraid that I can't offer you a better opinion without knowing more about your little girl.

What is it you want from the preschool? What path do you see your child following? Is her diagnosis high functioning autism, PDD-NOS or Asperger's and you see her as cognitively and language-wise on a par with others her age but the autism symptoms make things harder for her? If this describes your daughter, then what you want from the preschool and teachers might be help in having her understand how to be part of a group, how to interact with other children, how to follow routines and similar tasks that will help prepare her for when she begins kindergarten and the academic demands of grade one with her peers.

If your daughter is more affected by the autism and has an intellectual disability, you may still have some of the same goals. Life is a group affair for all of us. Knowing how to get along with others, to wait your turn, to follow instructions are skills needed no matter who you are, where you are or your stage in life.

Sometimes there are advantages when a teacher wants to treat a child like other children. Kids may rise to these expectations and do far better than we ever expect.

At the same time, you don't want to throw your child into a situation that totally overwhelms her. Some preparation is required. Here are some suggestions:

- go to the preschool with a camera. Take pictures of her the adults who will be in the room, the classroom, the door she'll use to enter the building, the washroom she will use, where she will hang her coat, where she will eat, etc.

- label the pictures and make a scrapbook at home for your daughter. Go over this book frequently with her, reminding her of who the people are, where she puts her coat, etc.

- Ask the teacher for a copy of the daily schedule and add this to your book. Before bed at night and before she leaves for school in the morning, go over the schedule of how her day will look

- to help Emma get used to the idea of a schedule, create one on your fridge for days when she is at home. Tape an envelope nearby that has pictures of things she commonly does during the day. Paperclip these pictures to the schedule so she can see what will be happening. As each task is completed, return the picture to the envelope. When she has choices, let her choose what to do from these pictures, put the picture on the schedule then take it down when the event or task is over

- take a look at the excellent website www.do2learn.com to get more of an idea of just how useful visual schedules are and download their schedule grids and free pictures

- when you take your photos, don't forget to include any outside areas, such as the playground and its equipment.

- take your daughter to the playground to practice using the equipment and so that she can learn the outside boundaries of where she may go when outside.

- at home, kids are fairly free in when and where they play. The world of school and preschool is different and things are run on schedule according to the teacher's time. This is a hard transition for most kids. You could practice at home by setting a timer. When the timer goes, it is time to change activities.

- social stories are a great way to prepare a child for what will be happening and what is expected of her. Some social examples are at sites like this: http://www.autisminspiration.com/public/department47.cfm

- does your daughter see any therapists? If so, is it possible to set up a meeting where they can talk with you and the teacher about what they have learned about Emma?

In what way does autism affect your child? What can you tell the teacher about her? Is she verbal? Does she understand and respond to oral direction? If not, how do you communicate what you want to her and how does she let you know her wants and needs?

If she becomes overwhelmed, how do you know that this is happening? What are the signs? What works to calm her? These are facts that would really help the teacher.

What is Emma's attention span like? While most preschools switch activities frequently to accommodate the short attention span of 3 year olds, some kids with autism can focus on one activity for a far shorter period of time. Again, this is good information for the teacher to have, although I would not necessarily base your daughter's whole program around the length of attention she shows you at home. I have seen kids make amazing growth once in a group of peers by following along.

Last spring I answered a question from a preschool teacher aide. You might find her take on things interesting. At the top of this link is her question and if you scroll down you'll read my response: http://en.allexperts.com/q/Autism-1010/2009/3/3-yr-old-student.htm

From time to time parents write asking if they should move to find better services for their child. At this link is one of the discussions on this: http://www.autismsite.ca/html/should_we_move_to_find_help.html

Right now, you are nervous and that is entirely understandable. I would suggest you give this school a try. Be calm and be patient. Be open to meeting to talk about strategies and goals. Connect with the special ed people in your school division. Hitches will occur but there are ways around them, especially if the adults involved share their knowledge and experiences with humor and openness and support.  You all want the same thing - the best experience possible for Emma. Most likely, once you give it time, you will see your little girl grow and blossom in this environment.

Best wishes,

Sharon A. Mitchell, B.A., B.Ed., M.A., PhD. Candidate
www.autismsite.ca





---------- FOLLOW-UP ----------

QUESTION: I just wanted to answer some of the questions about Emma. Emma was diagnosed with severe autism although she is mild mannered and transitions easily. She is hyposensitive, and craves proprieceptive and vestibular activities. She likes extreme movement like jumping and swinging. She is currently seeing a speech therapist and ocupational therapist. She will continue these therapies in preschool. She communicates mostly by leading and she has recently learned to point although she only point at highly preferred items- mostly food. She does not respond very well to verbal comands. She also does not respond to her name or if told to come here.

We wrote the teacher a ritual story that takes you through Emma's day from her point of view. Gave her a list of strengths, weaknesses, what to do when to calm her down, tips on how to get her to eat, and examples of ABA therapy that we working with her on at home.  I was really surprised when she didn't say how great it was to get this information. Oh well.

We do not have her on a picture schedule but will be attending a peccs training session in sept. I am hoping that this will give us the inspiration needed. I am having a hard time trusting the teacher, when asked she knows nothing about peccs. I am hoping that someone will lead her in the pecs direction- hopefully the speech therapist. She does not seem very open to parent suggestions. I am afraid that all she sees is paranoid parents and not knowledgble parents. I am hoping this will change after some time.

Emma has been assigned a para although I was told that they will be looking for a more qualified candidate. Preschool paras are only required to have a highschool education. I am told that she has worked with an autistic child previously so we are fortunate.

I want the best care for my child and feel that even if preschool goes well we should start looking where to go next. Is there specific areas that we should at moving to, or do you have any recomendations of schools. Which state, city provides the best autistic services.

Thank you so much for all your information, I am going to try and be patient and hope that the peer interaction will open her world. Would you say that in 6 months if she doesn't show improvement then we should re-evaluate our decision to stay?

I am going to take your advice and be patient, I am going to try and give the teacher a

Answer
When you say Emma will continue her SLP & OT therapies in preschool do you mean that you'll continue to take her to sessions or will she have her therapy right in the preschool setting? The latter would be ideal although logistics often don't allow for that.

It's nice that there will be a para involved. Hopefully you'll get to meet her and fill her in on what works for Emma. Is there by chance a rebounder or mini-trampoline in the preschool that Emma could use? A swing? A rocking chair?

The information you passed on to the teacher sounds very useful. I'm not sure how to explain the reaction you received. Some people are just not demonstrative. I've seen teachers react in that way but quietly take the material home, absorb it and use it.

I know of other teachers who refuse to look at files before meeting the child; they do not want to have pre-conceived ideas and prefer to take each student as they are. Perhaps that is the situation with Emma's teacher.

I hope you enjoy your PECS workshop. While the teacher may be unfamiliar with PECS, take a look around the preschool room. Early childhood educations fill their rooms with visuals. It's a rare preschool or kindergarten who does not use a picture board to demonstrate activities during the day. This teacher may not use the word PECS, but most likely she will be using visuals to communicate with the kids. Although I like PECS, I do know that some people shy away from it because they fear that properly following PECS is too much work. Really, it's not that bad, but can seem that way, especially when explained by some trainers.

I am whole-heartedly sold on using visuals with kids with autism. For those who are hesitant to get started, I like the way visuals are explained (and the free stuff) on the www.do2learn.com site. I also like the explanations and examples that Linda Hodgdons gives on her site at http://www.usevisualstrategies.com/.

I'm sorry that I cannot advise you on which city or state provides optimum services. That is such an individual assessment, depending on the individual needs of the child. I have seen severely autistic children flourish in small, rural settings with teachers who are new to autism. I have seen children in large city specialized autism programs who also flourished and others for whom these programs brought about minimal changes.

Although your daughter of course means the world to you and you would do anything to help her, she is one member of your family. Uprooting a family because of one individual is a major decision. You obviously are not without services where you are if Emma is lucky enough to see both an ST and OT. Sometimes even less than optimal services are offset by having a happy family life. Having jobs, having friends and/or family nearby are very important for the family and for your daughter.

Before seriously considering moving away, I would suggest you spend some time with your school division's special ed consultants and teachers, getting a feel for what life might be like for Emma down the road in their schools.

Good luck and I hope that in a couple months you write to tell me that you can see positive changes in Emma already since she has been in preschool.

Sharon A. Mitchell