Overview

Promoting Social Participation in Children Diagnosed with ASD

AIDE Canada
Following a diagnosis of ASD in a child, parents can sometimes feel disempowered. This kit is designed to help them better understand what the diagnosis entails, how best to support their child at home on their road to empowerment, and to restore their confidence in their essential role as parents. The kit includes scientific explanations as well as practical and easy-to-apply at home advice.
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INTRODUCTION

Dear Parents,

The news of an autism spectrum disorder (ASD) diagnosis in a child can throw off parents and loved ones. The main function of this kit is to address the various situations that families go through when a child receives an ASD diagnosis.

This kit, created based on credible data, will familiarize you with the vocabulary used by professionals with expertise in ASD. We believe it is vital that you have access to this vocabulary.

We have also considered that you probably don’t have a lot of time to devote to reading. By referring to the table of contents in the downloadable version, you will be able to read only the sections that apply to your child or that interest you.

You will find that the Recommended Interventions aim to help people acquire the skills that all children need. We are starting from the principle that a child with an autism spectrum disorder is, above all, a child. Whether they present with ASD or not, the child needs clear guidelines and stimulation from their parents.

The time frame for a child to acquire new skills is about a month. It is recommended to work on one element at a time. It’s not a sprint, but a marathon that requires time, endurance and patience.

YOUR INVOLVEMENT IS CRUCIAL!

This kit will help you target the skills your child needs to acquire to maximize their full potential and promote their involvement in society. The fundamentals that you teach in childhood are necessary for your child to function well and participate socially, especially when they become a teenager and an adult.

This kit is not a replacement for the services provided by healthcare professionals but is intended to be a helpful resource to consult as needed.

Enjoy reading,

Nathalie and Nadia

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NEURODEVELOPMENTAL DISORDERS

The “neurodevelopmental” label indicates that the issue has a neurologic origin and that this issue begins during the developmental period. The child presents deficits in their development that affect their daily functioning. A child can present a single neurodevelopmental disorder or several. As such, a child presenting with an autism spectrum disorder can also have an intellectual disability and/or attention deficit disorder. In this case, you need to make changes related to autism spectrum disorder and also to the deficits caused by an intellectual disability and the behaviours related to attention deficit hyperactivity disorder.

NEURODEVELOPMENTAL DISORDERS INCLUDE :

Intellectual disabilities

Communication disorders

Autism spectrum disorder

Attention deficit hyperactivity disorder

Specific learning disorders

Motor impairments

Intellectual disabilities

Intellectual disabilities include global developmental delay in preschool children, then called an intellectual developmental disorder if the child does not catch up and still presents difficulties at primary or secondary school.

Global developmental delay can be present in the child from birth or present in their early developmental years. This disorder is characterized by a general deficit in mental abilities and is diagnosed when the child does not meet normal developmental milestones. A child presenting such an issue will show

delays in at least two areas of development on an

intellectual (cognitive),

linguistic (speech or language), social or personal, motor (fine or gross motor skills) or daily activities level.

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RECOMMENDED INTERVENTIONS

Take action in all spheres of development and not just on language.

Use simple instructions, only one or two words.

Favour straightforward vocabulary (e.g. apple) before teaching abstract vocabulary (e.g. red).

Develop cooperation rather than competition.

Develop their functional autonomy (e.g. feeding themselves with utensils).

Perform simple tasks related to fine motor skills and gross motor skills (e.g. putting away toys).

Communication disorders

Children with communication disorders (or dysphasia) have gaps in their speech, language and/or communication. As such, a child can have difficulty pronouncing certain words, have a limited vocabulary, not be able to arrange words into sentences or not be able to describe a series of events. Contrary to children with a global developmental delay with linguistic delays or children with autism spectrum disorder who do not grasp the importance of communication, the child who only has a communication disorder wants to speak and communicate. They attempt to be understood through facial expressions, gestures or objects.

RECOMMENDED INTERVENTIONS

Avoid speaking for the child. Give the child time to express what they need, either through a word, image or gesture.

For children who don’t use verbal language, implement an alternative communication tool.

For those who use simple sentences to communicate, encourage an enriched vocabulary and teach them synonyms (e.g. a shoe, a slipper, a sneaker).

For those who have trouble interpreting inferences, teach them abstract terms, how to understand others’ feelings and how to empathize with others.

Autism spectrum disorder

Autism spectrum disorder

(ASD) affects social

communication and

stereotypic

behaviours. Other

spheres

of

development,

like

intellectual

functioning,

language, autonomy and

fine

and

gross motor skills may be affected in some

individuals. Children with this disorder are on a spectrum, and some of them may have trouble

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learning. While ASD may be associated with differences in intellectual functioning, language, autonomy, and/or motor skills, these are not integral to the diagnosis.

RECOMMENDED INTERVENTIONS

Develop verbal language or develop an alternative communication tool.

Promote activities, games, sports for two (e.g. a card game, badminton).

Attempt to reduce restricted and stereotypic

behaviours and interests that interfere with daily activities. Note that we are emphasizing interests that interfere with daily activities. We don’t recommend you forbid having interests, but rather that you ensure they are well coordinated so that the child’s full potential can be developed, and in different spheres too.

For those who have trouble with inferences, teach them abstract terms (e.g. I placed the book over there).

Attention deficit hyperactivity disorder

Children with attention deficit hyperactivity disorder (ADHD) can appear distracted and lack perseverance for activities that are not interesting to them. They may exhibit impulsivity or behaviours that show excessive agitation in situations where it is not appropriate. In general, the child appears to not listen to instructions, has trouble concentrating on a story and struggle to complete their work. They may struggle to sit still, may interrupt others or hum when it isn’t appropriate. Imaginative play may appear disorganized, with no beginning or end.

RECOMMENDED INTERVENTIONS

Get the child’s attention by touching their shoulder before giving them instructions.

Expect appropriate behaviour following the given instruction (e.g. by expecting that the child sits when the instruction is “sit).

Promote a routine made up of simple and clear rules (e.g. getting dressed, having dinner, watching TV).

Promote a calm environment without too many objects or noises.

Teach your child to be organized, clean up and put their things in the right places.

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Specific learning disorder

A specific learning disorder is characterized by learning difficulties and difficulties using academic skills in a particular domain. This disorder comes in three forms:

Reading disorder (dyslexia)

Written expression disorder (dysorthographia)

Math learning disorder (dyscalculia)

Children with learning difficulties may have trouble reading words properly, understanding the meaning of what is read, memorizing the spelling of words or grammar rules. Those with dyscalculia may

struggle to

grasp the

meaning

of

numbers, calculations, or mathematical reasoning.

RECOMMENDED INTERVENTIONS

Read with your child for at least 15 minutes a day.

Read texts on subjects that interest them.

Encourage writing, ask them to write emails and texts.

Help them memorize the spelling of words through games.

Incorporate mathematics during daily activities (measure quantities of food, count toys, calculate the time spent taking a bath).

Motor impairments

Motor impairments (or motor dyspraxia) are defined as difficulties in acquiring and executing movements, either fine motor skills or gross motor skills. These impairments are divided into three categories:

Developmental coordination disorder (DCD)

Stereotypic movements

Tics

Children presenting with a DCD are often described as clumsy, tending to drop objects or bump into others. They may also have trouble catching or throwing, jumping or climbing. They have trouble using utensils, scissors or crayons to draw or colour. Those with stereotypic movements perform repetitive, aimless motor behaviours that interfere with their daily lives. Children’s tics can be a sudden, quick, recurring, non-rhythmic movement or vocalization.

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RECOMMENDED INTERVENTIONS

Divide motor tasks into simpler and shorter tasks (e.g. fastening clothing with large buttons or a snap button).

Teach them how to organize and plan their tools and games (e.g. getting all their tools out before starting their homework).

Develop a series of movements that the child should follow (e.g. Wet the toothbrush, put toothpaste on the toothbrush, then gently brush teeth).

Help them make fluid movements (e.g. dance movements).

Explore new games and sports (e.g. karate, yoga).

AUTISM SPECTRUM DISORDER

Autism spectrum disorder (ASD) is characterized by the presence of persisting difficulties in communication and social interaction, as well as the presence of restricted or repetitive behaviours, activities or interests. These difficulties should be observed in various contexts. Although they are often present in early childhood, these characteristics may not be noticed until later. For example, diagnoses may happen after a teacher at school notices that the social demands on the child are exceeding their current abilities.

Persistent deficiency in communication and social interaction

THREE CATEGORIES :

Deficits in social-emotional reciprocity

Deficits in non-verbal communication

Difficulty developing, maintaining and understanding social relationships

DEFICITS IN SOCIAL-EMOTIONAL RECIPROCITY

Difficulty sharing their interests, opinions and emotions with others.

Lack of skill when initiating or reacting to social interaction.

Unease when being comforted by an adult or a peer.

Difficulty reacting to signs of affection.

DEFICIT IN NON-VERBAL COMMUNICATION

Avoiding eye contact.

Somewhat neutral facial expressions.

Little smiling.

Difficulty coordinating verbal and body language

DIFFICULTY DEVELOPING, MAINTAINING AND UNDERSTANDING SOCIAL RELATIONSHIPS

Difficulty adjusting their behaviour to different contexts (running around a shopping centre, not answering when asked a question).

Little interest in imaginary or symbolic play.

Lack of ability to make friends.

Little interest towards others.

Preference for solitary play and activities.

Restricted or repetitive activities or interests

FOUR CATEGORIES :

Presence of stereotypic or repetitive movements

Insistence on sameness, inflexible adherence to routines, ritualized patterns of verbal and non-verbal behaviours

Restricted and fixated interests that are abnormal in focus and intensity

Sensory hyper- or hypo-sensitivity to various stimuli in their environment

PRESENCE OF STEREOTYPIC OR REPETITIVE MOVEMENTS

Likes to make simple and stereotypic movements.

Shows an interest in manipulating objects (aligning them or twirling them).

Repetition of words or phrases.

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INSISTENCE ON SAMENESS, INFLEXIBLE ADHERENCE TO ROUTINES, RITUALIZED PATTERNS OF VERBAL OR NON-VERBAL BEHAVIOURS

Distress about changes, unforeseen events, transitions.

Presence of rigid behaviours or thoughts.

RESTRICTED AND FIXATED INTERESTS THAT ARE ABNORMAL IN FOCUS AND INTENSITY

Attachment to objects (toy cars, rocks, strips of paper).

Restricted interests in what they like (numbers, colours, animals, vehicles, etc.).

SENSORY HYPER- OR HYPO-SENSITIVITY TO VARIOUS STIMULI IN THEIR ENVIRONMENT

Apparent indifference to pain or temperature.

Aversion to or interest in textures, odours, sounds.

Fascination for lights or movements.

LEVELS OF SUPPORT FOR ASD

3 LEVELS OF SUPPORT :

Level 1 : requires support

Level 2 : requires substantial support

Level 3 : requires very substantial support

The three levels of support describe the autism spectrum. Referred to as 1, 2 and 3, the levels indicate the amount of support the child needs in their daily lives. The higher the level, the more support is required. As such, a child needing level 1 support requires help from an adult.

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At the other end of the spectrum, a child needing level 3 support requires a great deal of help from an adult to function.

Level 1

A child at this level needs help to do daily activities. There is a persistent deficit in communication and social interaction. A child at this level could, for example, have trouble initiating social contact with other kids at daycare or at school, but will answer them if they are approached and invited to play. This same child could seem to prefer playing alone, but will participate in a fun activity with family, especially if it is suggested by a parent. Though the child may have access to verbal language and be capable of using fluid language, their attempts to initiate interactions will often be ineffective or awkward.

Restricted or repetitive activities or interests. A lack of flexibility in their behaviour is often visible. This deficit has repercussions for daily functioning. For example, a child can have trouble cooperating during bath time in the afternoon but not in the evening even when they’re dirty, or have trouble brushing their teeth with a different flavour of toothpaste or refuse to wear boots because winter hasn’t started yet.

EXAMPLES OF LEARNING OBJECTIVES

A persistent deficit in communication and social interaction

For children/adolescents that want to develop this skill, working towards making intermittent eye contact during conversations.

Answer questions about a story.

Restricted or repetitive activities or interests

Wait their turn to play or speak.

Follow the rules of a board game.

Put away their possessions in the correct places.

Level 2

A child with ASD at level 2 requires substantial help from their adult. There is a persistent deficit in communication and social interaction. A child at this level does not have the knowledge necessary to understand instructions and express their needs, desires and emotions. As such, the child could require visual aids in the form of images. Though the child may have some verbal language, it will often only be used to answer the adult’s questions or express concrete needs like eating and drinking, playing or resting. Language is rarely used to question others or make comments.

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Restricted or repetitive activities or interests. The lack of flexibility in their behaviour is more apparent. As such, the child may play alone the majority of the time and their use of toys and games is not always appropriate. For example, they may line up or stack blocks, but never make more detailed constructions, such as a bridge or staircase. Their autonomy when it comes to getting dressed, hygiene and toilet training is developed later than usual.

EXAMPLES OF LEARNING OBJECTIVES

A persistent deficit in communication and social interaction

Turn towards a person in response to their name.

Make spontaneous requests using sentences of two or three words.

Restricted or repetitive activities or interests

Make patterns with blocks, beads, figurines, etc.

Dress by themselves when asked to do so.

Level 3

Children with ASD at level 3 require very substantial support from an adult. There is a persistent deficit in communication and social interaction. When it comes to verbal and non- verbal abilities, children at this level acquire little functional communication skills. They use single words to indicate their needs, if asked by the adult. They can use sentences of a few words if they are repeated immediately. The majority of children need a communication tool other than oral language, adapted and personalized to their interests and generally used with the help of an adult. Their social relations with the adult are poor and friendships are often non-existent.

Restricted or repetitive activities or interests. A child at this level prefers solitary activities, playing tangible and repetitive games without using their imagination. All stages of development must be supported by an adult, whether that be for nutrition, hygiene, communication, social skills, fine or gross motor skills, games or hobbies.

EXAMPLES OF LEARNING OBJECTIVES

A persistent deficit in communication and social interaction

Sit down on their own and remain seated on a chair.

Point out images in a book or with help from their communication tool.

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Restricted or repetitive activities or interests

Associate objects, images, shapes or colours according to instructions.

Feed themselves using the appropriate utensils.

Get undressed without help.

SOCIAL ABILITIES

Positive social interactions promote healthy development and teach children how to better adapt. Relationships with peers are important because they allow children to develop their social skills through different activities. Furthermore, those learned during childhood make up the foundations of proper functioning in adolescence and then in adulthood. Also, through various activities, children get to know their social environment, increase their communication skills and put themselves in others’ shoes.

Children with ASD have poor social skills. As such, they suffer from social isolation because they don’t know how to begin interactions with their peers. Children with ASD are often awkward when interacting with other people and consider their interactions as being negative experiences in which they may experience rejection. Since the social consequences of this can last a long time, it is not rare for people with ASD to continue having difficulties into adulthood.

Courtesy

Long before teaching social skills, children should be introduced to politeness and good manners. A child can learn to be polite at a very early age. They are introduced to the rules of politeness by

observing their parents. Then, when they start talking, they learn little by little how to say “thank you” and “please.” However, teaching politeness requires patience. You may need to remind your child often to use the “magic words.”

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IT’S WORTH THE EFFORT !

By being polite, your child will be better liked by adults and

have an easier time making friends.

Teaching good manners requires time, patience and perseverance. This should be taught as early as possible by being a role model to your child, requiring them to act properly and taking advantage of every opportunity to praise the correct behaviour.

At around 4 years old, children develop their social skills. It is a good idea to use this development period to encourage the acquisition of courtesies such as “please” and “thank you.” If the child is non-verbal and uses a picture exchange communication tool, it is possible to add the word “please” at the end of their sentence strip. As such, an adult receiving a request from the child will read apple, please, which is a more pleasant way to receive a request. The word “thank you” could also be added to their communication tool or they could be taught the sign for thank you.

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RECOMMENDED INTERVENTIONS

Teaching good manners during snack and meal times: washing their hands before going to the table, using utensils and a napkin, taking small bites, having a good posture, etc.

Using greetings such as “hello” and “goodbye” during social interactions.

Sneezing or coughing into their elbow and blowing their nose with a tissue.

Removing their shoes/boots and their cap/hat when they enter the house. Hats should also be removed when entering a restaurant or when there is company.

Knocking or ringing the doorbell before entering a house is also a preferable behaviour.

Teaching the child not to interrupt a conversation, whether it’s an exchange between two or more people, a phone call or a videoconference. Visual reminders can help the child learn and strengthen this social skill.

STEREOTYPIC, REPETITIVE BEHAVIOURS AND RESTRICTED INTERESTS

Hand gestures, spinning or jumping are stereotypic and repetitive movements commonly associated with autism. These behaviours can hinder communication and the use of objects.

Echolalia may be observed in children with ASD. Some children will repeat word-for-word a line from a movie or an episode from a TV series that they particularly like.

Unusual playing practices are often observed. The way they manipulate toys is repetitive and unconventional. For example, rather than making toy cars roll around and creating race tracks for them, the child may line them up or turn them over to look at the wheels. The toy provides sensory stimulation that could be auditory, olfactory, tactile, gustatory, vestibular or proprioceptive.

After preschool age, a child usually develops new interests. These can be qualified as atypical or typical for children their age. Usually, it is their intensity that makes the situation difficult for the child and their family, mainly because the restricted interest leads to (causes) a breakdown in daily functions.

Strong emotional reactions can be expressed when parents try to set limits to a child’s restricted interests. However, a school-aged child must acknowledge their responsibilities, such as sleeping, taking care of their personal hygiene, cleaning their room, doing their homework and eating with their family before engaging in their interests.

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