Expert: Dr. Sharon A. Mitchell - 11/8/2007

Question
QUESTION: I am a special ed.para, I work with 2 children that are autistic.  One child is non-verbal the other is very smart but has a short attention span and has a behavior problem. He will not sit for 2-3 minutes to do his worksheets that the teacher has given me to work with him, but he can sit for 2 hours playing on the computer.  When i set the timer to give him a time to play then a time to do worksheets he throws a tantrum when the timer goes off.  He starts kicking chairs over and hitting other children in the class.  He acts out when he doesn't get his way.  When i question his mom to see how she handles this at home she says they just let him be.  So whatever i do at school it is not enforced at home.  I am new to teaching autistic children and i am willing to learn anything to help out these children.

ANSWER: These children are lucky that you're taking an interest and wanting to learn more.

Short attention spans often go along with autism. Conversely, kids can often demonstrate an inordinately long attention span when the topic is something in their area of interest, such as your student shows with the computer. His ability to zone in for lengthy periods of time on the computer does not imply that he does not truly have a short attention span at other times.

But even with a short attention span, he can learn to comply and do what he's asked in shorter spurts.

First, is he able to do the worksheet task? Is it at his level of learning?

Is his objection to the worksheet that it takes him away from doing something more desirable? Does he object to doing the worksheet when classmates are doing something else?

Does he always fuss about the worksheets or is he more amenable at other times of the school day?

What is the curricular objective the teacher is aiming to teach through the worksheet? If the actual worksheet is the issue, is there another he can learn about or demonstrate his knowledge of that concept? For some students, a more practical application of the skill can be more meaningful than a worksheet.

Worksheet or not, it's essential that he do some work in school. Like it or not, all students must. Actually, all adults must do things whether they feel like it or not.

Remember that old adage, "First we work, then we play"? That could be the case with your student.

Most kids with autism take in information far more readily visually rather than by listening. Make a card to put on his desk. It could say something like:

First________________________ Then _____________________

In the blanks you might use pictures rather than words, if you student responds more readily to pictures. If he's quite young and new to visuals, take actual photos of the worksheet then say the computer (which would be the Then).

To begin with, make the required task something you know he can do in a matter of a minute or some other very short period of time. It need not be a paper/pencil task but even something like hanging up his coat. Then the instant he's done what you asked, show him the Then picture (or word) and let him have his reward of doing that preferred activity. Coupling the request with the reward may take a number of trials until he gets the idea.

Gradually you can make the First task longer or more complex, increasing his time-on-task before he gets his reward.

Then you could gradually decrease the amount of time he gets to spend on the reward and up the time-on-task.

You may find that the reward fades, meaning that it does not hold his interest as well as it once did. Change rewards. Let him be involved in settling up a list of desirable activities or rewards.

You'll be surprised at what kids like as rewards. They don't always choose activities like using the computer. Some like to the opportunity to go say hello to the principal, tidy a book shelve in the library, go for a drink, etc.

I like that you're using a timer. Is it by chance a visual timer? By that I mean a timer that SHOWS the student how much time is left. You can take a look at one here:

http://www.ed-solutionsdirect.com/resources/timetimer.htm

This will not necessarily go smoothly at first, as I'm sure you're aware. But initially making the task requirement easy and very short, and immediately coupling it with the reward will help but down on the tantrums. I know it's not easy, but respond to his behaviors calmly, not matter what you're feeling inside. He'll still need to do the task once he's calmed down and before he can get his reward.

If he's hurting other kids you may need to begin this training in a corner, away from the others or in another room then gradually move him back to the main group.

He's tantrumming anyway now, so you don't really have a lot to lose by trying.

Think of what it's like for you when you have this child say five hours a day and he tantrums. You'll be drained and glad to get home. But his mom then has him 19 hours a day. She may have been through three such tantrums with him before he even got to school.

Most kids with autism have sleep disorders. They either can't get to sleep or they do but then wake up frequently during the night. (Our son slept not more than ten minutes at a stretch for his first few years and for about 1/2 hour at a time until he was five or so). Think about what that means in a household, how vigilant the parents need to be.

Think of how you feel when you've had several nights in a row of poor sleep. You don't think as well as usual. You're edgy. Things rub you the wrong way much more quickly than when you're well-rested. It's harder for you to make it through the day.

Think about a child who is continuously sleep deprived. Likely he feels he has just one nerve left and you're getting on it.

Think also about his mom. When you have a sleep-deprived child, you also have a sleep-deprived parent. She may be hanging on by her nails and have little left over.

I'm not condoning the fact that she says she just lets him be (or do what he wants at home), just trying to explain how it might be from her point of view. She's likely seeking a few minutes of peace. And, most of us find it easier to use all our skills when we're at work, then when we're at home.

It says something about the relationship you've established with this mother that she's willing to be so frank with you. She must trust you and be willing to team with you.

If you begin this First_______ Then_________ process, you'll be helping the family as well. The skill he learns at school can eventually carry-over at home. You can share with the mom the same First________ Then___________ card you're using. Explain your plan. She may be willing to try to implement the same thing at home, although she might be more able to try once you've gotten the basics established at school.

Even if the family never tries the same plan, that's still all right. If you get him to be more compliant at school, you've accomplished a great deal. And kids can learn that different rules apply in different situations.

Best of luck,

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









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

QUESTION: I already use something like the first and then: i have a computer sheet with a person sitting at a desk working on one side and on the other side it has 3 choices (computer, games or reading a book)but he can't get a reward until he atleast completes 2 of the 4-5 worksheets that the teacher gives us for the day.  This child is capable of sitting with me and completing a worksheet, i read it and he can do what it says with my help. I will keep trying the first and then rule like you say and see how that works and i will get back to you and let you know how we progress.  Thank you.

Answer
Yes, you can most certainly get back to me. I'd like to know how things are progressing.

Kids with autism can be confusing, especially when they seem bright and capable. But you might not be able see some of what's going on inside.

Time is a difficult concept for many people with autism. While you know and most of the children in the classroom know about how long it will take them to do two or four worksheets, your student autism likely does not have that concept in his head. To him, it could seem as if those sheets (even just two of them) will go on and on forever, especially if they are activities he does not like to do.

I'm not clear from your description how the requirements are set up. Does he need to finish the two sheets entirely before he gets to pick from the three choices? Does he need to do all the work before he gets his reward?

You might have better success if you work in very small time increments. Rather than completing a whole sheet, what if he did five or even two items on the sheet then he gets x amount of time at his preferred things?

Some kids with autism become visually distracted or overwhelmed. Looking at a whole page seems daunting. You could try:

- cutting the worksheet page into strips and giving only one strip to do at a time
- fold the page so he only sees part of it at a time
- cover some of the page wtih colored paper, moving the marker down as he finishes each row
- let him pick any three on the page to do, then he gets his reward. Then he can choose another three, and have a break or reward, etc. until the page is done

Fine motor control is a weak area for most kids with autism. Thus, holding a pencil can be a trial. It's not that the child can't, it's just harder for him than for other kids. His hand will tire much more quickly. He may have to concentrate harder than his peers in order to guide the pencil and make the writing legible. (Some studies are showing structural differences in the brain of people with autism, with the cerebellum being 17% smaller. It's postulated that this may partly account for the fine or gross motor difficulties common in autism).

It's also not uncommon for people with autism to have a slightly odd gait when walking or running. They may have weak muscles in their trunk (hips to shoulders). This makes sitting upright in a desk much harder than for typical children. You may see such kids slumping, changing position, wiggling, putting their head down on the desk, holding their head up with their hands and other such behaviors. What can look like inattention or hyperactivity in this case can actually be a child with weak trunk muscles or trunk instability trying to remain upright when he's tired.

You can help the above things by trying different positioning, such as:

- have him write on a slant board. It's more tiring for the hand and arm to write on a horizontal surface. Raising the surface can help. A slant board could have a four inch rise on one side with the other sloping down the the desk. At the high end it's handy to have a clip like those found on clip boards to steady the paper. In lieu of a proper slant board, you could use a 3 or 4 inch binder placed on its side.

- sitting on something other than a desk chair can make a difference for some kids. Try using a therapy ball (exercise ball) pulled up to a table. Try a small, inflated cushion placed on his desk chair. You can purchase many types. If you're reluctant to spend much when you don't know if it'll work, buy a child's blow-up beach ball or one of those blow-up plastic rings small children use to help them float in the water. Blow it up enough so that it's an inch or so high and see if he likes to sit on it. He'll likely squirm but that squirming can have an alerting effect and actually help him remain on task, rather than distracting him.

Some kids don't like to be different from their peers. Is there a chance that no matter how much this boy might like you, he does not want to be the only kid who has an adult sitting by him? Would he accomplish any small part of the worksheet if you made a deal with him about how much he was to do on his own before you return to check?

This might be beyond the scope of your job description, but is a worksheet the only way in which this boy can show his knowledge? Is there another, more applied way of getting his to practice the same concept?

How well can you communicate with your student? What does he have to say about all this?

Have you pointed out to him what his peers are doing? You may have to be very blunt and state the obvious.

Are you familiar with the concept of using social stories? A social story about how we work or what is expected might help your cause. Here's some information on using social stories:

http://autism.healingthresholds.com/therapy/social-stories#rowe

http://www.adders.org/socialstories.htm

Here's a social story about being angry:

http://autism.about.com/od/treatmentoptions/l/angry.pdf?nl=1

On looking at your question again, I still think that time might be a factor and you might have more success when you break the required task into very small, (to him more manageable) steps, with frequent, small rewards.

Sharon A. Mitchell