Couple of days back I was looking at the instruction manual for a new intervention that we started for our son and I was trying to be very careful as I was handling the expensive device. Mid way through the process I realised I was hardly reading the text and relying so much on the pictures – how the amplifying unit should be charged, and what cable must connect to which point etc.
Difficulty transitioning. I was reminded of the early days when I photographed my child doing things in the daily routine, took prints and laminated them. Then I would sequence them and hang them up as morning routine and evening routine. There was a sequence of pictures for brushing as well. I even had pictures on the bathroom door, to remind him to shut the door when he entered the bathroom. You may think I got tired of telling him what to do or not to do, so I found a way out to get things done. No, I wasn’t tired. Yes, I definitely got things done! It seems so strange that every morning you wake up your child and he just doesn’t seem to understand that he needs to go through his bathroom routines and then get dressed, eat and leave for school. Being sleepy, being lazy, not wanting to go to school, giving excuses for not being able to wake up are what kids would do normally. Frustrating but at least I could identify with those. However, this wasn’t like that. And during brushing, he didn’t seem to remember how to get through with it despite it being the nth time. In the mornings, for some reason there is always less time and our tolerance levels are way lower. The struggle to transition had become just another part of our morning routine. Then ABA therapy entered our lives and I was told that most autistic kids are visual learners. The first visuals I made were for the morning routine and the teeth brushing sequence. He would look at each step and copy the same. I think for the first few weeks every morning and night, I would stand next to him while he is brushing and he would see the visuals and when done feel so happy. It was slow but we were happy that it was smooth and there were no meltdowns. I was already thinking about how I would have to carry these visuals everywhere I went! And then a month or two went by and we were having guests at home so I took off the visuals for that evening. Next morning, he was brushing his teeth and I realised I had forgotten to put the visual back on. He did all that he was supposed to do perfectly. I only realised then that he wasn’t using these visual routines anymore. He was actually relying on his own memory and skills. We get so caught up with new problems we don’t see the older ones getting resolved!
Countering Anxiety. Another big one which we managed to resolve was our child’s excitement every time we were boarding an aeroplane. While it is a good thing to be excited, for us it turned into a worrisome start to (and end of) an otherwise good holiday. From when he was around 2 until now, this extreme desire to be on the plane has not changed. From the time we are near the airport, it is like we have a bomb ready to explode. He finds it difficult to queue up to check-in the baggage. At the immigration/emigration checks he would have tears rolling down as he can’t wait. During security clearance he found it difficult to part with his toy aeroplane and the meltdown starts. The excitement has now changed into high level of anxiety. And then it’s impossible to sit in a café or buy a beverage as he won’t allow it. We just prayed that the flight wouldn’t be delayed. We tried everything from favourite rhymes to videos but they could only distract him for a few minutes. We would walk pretending that we haven’t reached our boarding gates while he stayed distracted by the aeroplanes taking off or landing. Every flight from age 2-5 has been so stressful. The irony is, on the flight when all other kids are restless, ours is the best. On one occasion I had a couple sitting close to us compliment us on how lovely our boy was in the flight. They definitely didn’t see him at the time of boarding and I hope they didn’t see him at the baggage collection. We always had to deal with another meltdown at the conveyor belts as he would want to run back to board the plane we just got off! From the fifth year, for all our air travels I had a laminated visual checklist. I was so proud of myself after seeing how effective it was. It had images from google of every step of the entire airport routine until we landed and got into another taxi. Then a picture of the place we are visiting followed by the next flight back home. He got to check the box every time we finished a step and this lowered his anxiety. Of course, Rome wasn’t built in a day, and our problems too took time to resolve but what mattered to us was we saw a marked decrease in his anxiety with every travel me made. I reused the same checklist until he turned 7 after which I stopped. For all travels in the last one year or more he has been very comfortable with the queues and wait times.
Removing dependencies. At school, the facilitators noticed that after every step, in readers workshop, my son would approach his teacher to inform her he finished the particular instruction and would ask her what he needed to do next. Even if she told him what the next couple of steps were, he would still go back after each step. So, she put in place a checklist of the instructions/ steps and a stamp size laminated picture of our son. Every time my son finished a step in the process, he would put his picture against the next step indicating he is working on that step and on completion he moved the pic to the next step and so on. He no longer needed to check with the teacher at each stage. This helped him do the entire task independently. Overtime it also gives a sense of awareness that he doesn’t need help all the time and can attempt tasks on his own. This is very important because children who are facilitated in class room environments tend to be habituated or feel dependent on their facilitators. Having checklists like these, helps remove unnecessary dependencies.
Evoking response. Social Stories are quite an important tool for children with ASD. These are basically visual stories custom made to the child’s needs. A story a day is definitely better than a monotonous lecture every day! We had many written for our son. From helping him get rid of his habit of squeezing his fingers, to staying on track in music sessions at school to seeking help if someone is mean or bullying him, we outlined many visual stories and read it out regularly to him so we can instil a certain response. Often social stories end with what the child’s response should be. And a visual story has the best effect. Pictures from the child’s own setting is preferred so the child can connect easily to the story.
Tips and tools. Visual tools like visual reminders, visual routines, visual checklists, visual schedules can really help your child deal with stress and anxiety due to new tasks, new places, or new people and also help in transitioning difficulties. These visuals should be placed or hung on the wall at the child’s eye level. To give a sense of control and accomplishment, you can have your child use a white board marker to check the box next to the activity when it is completed. I would say that very often we need to be prepared to let go of the aesthetics of the house for the benefit of the child! When we started exercise routines with our son, I had pictures of exercises laminated and we would just re-arrange the pictures for our sessions as it wasn’t always a fixed routine. While Velcro is often used, we found Prestik (a reusable putty like adhesive) which helped put these visual aids in play. It’s always a good idea to make aids that are reusable. The more effortless it is, the more we are inclined to use it, thereby evoking better responses from our children. There is also an app called ASD Tools which really helped our son get through changing routines and tasks with ease. It allows to click pictures and you can make a sequence of tasks that need to be completed. Your child then gets a visual schedule (First-Then-Next) and you have the option of introducing the picture of the reward at the end of the task. For the child the processing of instruction is a lot simpler and you get to make the visual on the go with this app based on the needs of your child.
It is easy for us to assume that a task is simple enough for our child. But it is possibly not the case for our child on the spectrum. It is probably more or as difficult as it would be for you to install something the first time round without a manual. It is still not an apple to apple comparison as your neuro-typical skills help you manage the scenario but that’s not the case with the ASD child. Why limit the power of visuals to just the school or ABA sessions? Why not use it to tackle situations at home and see how it can empower you and your child.