IELmoderator
Greetings, IEL Chat participants. Welcome to our IEL Chat on "Handling Challenging Behaviors in Child Care and at Home: Autism." To get started, let me introduce our guest speaker, Alyson Beytien, Assistant Project Director of the Illinois Autism/Pervasive Developmental Disorder (PDD) Training and Technical Assistance Project, in La Grange, Illinois, a suburb of Chicago.

Alyson Beytien
Children with autism present difficult and puzzling behaviors that often impair their ability to function and participate in their daily environment. Assisting the child in reducing these behaviors requires consistent, effective support and teaching from all the adults in their lives.

IELmoderator
The procedure for the live Chat session is as follows. Participants can send questions to the chat guest at any time. When you send your question, please note that it will not be visible to all chat participants. The IEL Moderator receives the question first and will post it to the whole chat group. If there's a long queue of questions, the Moderator will notify the questioner that the question was received. Then, at the next break in the discussion, the question will be posted for all to see and for our guest to answer.

Note that there will be a pause after a question is posted while Ms. Beytien composes her answer to the question. During these pauses, the Moderator will post occasional information about the IEL Web site.

Questions will be posted in the order they're received, unless there's some obvious reason to group similar questions together. Participants may send follow-up questions. If your question is not answered by the time the Chat session ends at 8 pm, the question and its answer will be included in the Chat transcript that will be made available online approximately 3 weeks from today.

Now let's begin our Chat. Ms. Beytien, we have a question that we received in advance of the session:

I have heard that puppet play is especially effective for adults who want to engage and communicate with autistic children. Does this work?

Alyson Beytien
I have not heard of a particular therapy based on puppets. Imaginary play is one of the largest areas of challenge for our young kids with autism. They are typically concrete, literal learners who struggle with representational objects. In the early critical years, we recommend presenting information in short, structured teaching moments that involve concrete and literal learning. For a child who is struggling to understand that the verbal word "dog" is a real animal that has four legs and fur, it might be too challenging to make the next leap and envision that "dog" is also made of fabric and sitting on the adults hand. This leap in learning could be introduced once the original concept was understood, however.

Dee R.
Can you explain why there is an increase in autism?

Alyson Beytien
Dee R., there are numerous reasons for this increase in autism. There is certainly a small percentage of the increase due to better diagnostics, due to greater access to medical professionals throughout the country, and due to better reporting within educational systems and government agencies. This does not, however, cover the huge increases being posted by the Centers for Disease Control and National Institutes of Health. The increase can then only be a true increase in children being affected by this neurological disorder.

IELmoderator
The transcripts of the IEL Chat sessions from 2002 are archived on the IEL Web site. Go to the IEL Chat page at: http://illinoisearlylearning.org/chat.htm, then scroll down the page to the section called "Past Chat Sessions." For each Chat in that section, you'll see a link for "Chat Transcript." Click on that link to view the transcript for that particular Chat.Editor's note: This url has changed: http://illinoisearlylearning.org/askanexpert.htm#pastchat

Todays Child
Can someone have both PDD and ADD/ADHD?

Alyson Beytien
Todays Child, the answer is yes. There is definitely layering of issues and challenges between many of the neurological disorders. The real challenge is determining which term best fits the child.

MSer
What causes autism?

Alyson Beytien
MSer, that is a question that the whole world would like an answer to!!! The reality, at this point, is that we just don't know.

IELmoderator
Ms. Beytien, we have another related question.

eileen
Do we know what causes autism? Is it a genetic abnormality, environment, or a possible combination of both?

Alyson Beytien
eileen, current research definitely finds a genetic link to the diagnosis of autism. We do not know as of today, what the exact affected chromosomes are, but there are at least 3 consistently affected chromosomes in all individuals with autism. But it is also widely believed that it is a genetic predisposition to a variety of triggers. The triggers could be environment, diet, immune system challenges, or other possibilities.

IELmoderator
The IEL staff receives many questions concerning the Illinois Early Learning Standards that were published last year. The text of these standards is available on the IEL Web site at the following URL: http://illinoisearlylearning.org/standards/index.html. The standards relate to the learning areas of (1) Language Arts; (2) Mathematics; (3) Science; (4) Social Science; (5) Physical Development and Health; (6) Fine Arts; (7) Foreign Languages; and (8) Social/Emotional Development.

SandyShine
How could I go about keeping an autistic child busy in my home day care center—such as games I could play?

Alyson Beytien
SandyShine, the challenge for the child with autism is understanding what to do when given free time and play. Children with autism struggle to play the basic games of childhood and monitor their own activities. They will respond best to a visual schedule that delineates activities available and the order in which to participate in them.

buddy
Why would an autistic child display escalated self-injurious behaviors immediately after school, and what is the best method of controlling them?

Alyson Beytien
buddy, my guess is that the child has held himself together during the overwhelming challenge of a school day and when he arrives home to the safe environment of his family, he feels comfortable "falling apart." The best way to assist the child is to provide sensory support and/or calming activities on a schedule so that the child can relax after the hectic school day.

Mowger
Thank you for the opportunity for providers to participate in your online live Chats. I found music to be a very good way to "communicate" with an autistic child of any age, and with an older child, the computer seems to work very well. What are some other triggers to create a response from an autistic child?

Alyson Beytien
Mowger, it sounds as if you have already learned the "trigger," which is to observe the individual child to determine what is most calming for them. At our house, we have had the same success with computers and music, and have also had success with bouncing on a trampoline, watching a video, playing with favorite toys, etc.

Jules
I work with a child who has a very hard time using her words to express herself. She gets very frustrated very quickly.

Alyson Beytien
Jules, I assume you are asking how to lower the frustration level in this child. Remember that autism is largely a communication disorder. If verbal language is not available to the child, there would definitely be frustration, and the level of frustration would increase. The key is to give the child another means to communicate, such as a picture exchange system, augmentative communication device, or sign language, so that she is capable of communicating her needs.

Todays Child
Is fragile X part of the PDD spectrum?

Alyson Beytien
Todays Child, yes, however it is rare. It should still be tested by a geneticist so that it can be ruled out.

IELmoderator
Again, concerning the Illinois Early Learning Standards, each learning area has one or more standards. For each standard, there are one or more "benchmarks." On the IEL Web site, you can find links from these benchmarks to various activities on the Web that relate to that benchmark. The Illinois Early Learning Standards have recently been translated into Spanish. This Spanish version will be added to the IEL Web site over the next several weeks.

Dee R.
Do you find better help for autistic children in regular classrooms or centers?

Alyson Beytien
Dee R, I believe that the best learning environment for children with autism is in an educational setting that provides opportunities for interaction with typically developing peers for at least some portion of their day. There should be trained personnel as part of each child's educational team in order for learning to occur. This can happen, if supported properly, in a typical classroom.

Nancy
Does a caregiver or parent need to deal with challenging behavior in an autistic child in a different way than with such behavior in a child who is not autistic?

Alyson Beytien
Nancy, yes, typically. Our children with autism do not process auditory information quickly or effectively. Simply telling the child to stop the behavior or resorting to spanking or time-out does not make sense to the child with autism and may in fact reinforce the behavior.

IELmoderator
You can find additional resources on autism in the supplement to this Chat session. This supplement is available on the IEL Web site at this URL: http://illinoisearlylearning.org/chat/beytien/sup.htm.

MSer
The administrator in my child care center wants me to include a child with autism in my class of 4-year-olds. I don't think I know enough to handle a child with autism in addition to the other kids. I am thinking of quitting. Do you have any ideas for how I could handle this?

Alyson Beytien
MSer, yes, and great question. Illinois state law requires a district or child care center to have an expert in that child's disability available to the staff. Training for you, and other members of the staff, should be written into the child's IEP as necessary. Training can be provided to you for free through the Illinois Autism Training Project. Visit their Web site at: http://www.theautismprogram.org.

Jules
I work with a child who has a very hard time using her words to express herself. She gets frustrated very quickly and I often have a hard time trying to figure out what the problem is. She does use some words, but her vocabulary is very limited. Do you have some suggestions as to how I could regain her attention to try and work things out before we get to the screaming stage, which sometimes happens very quickly?

Alyson Beytien
Jules, I spoke about this in a prior response regarding visual communication systems. If you have specific questions, please feel free to contact me through the Illinois Early Learning Project contact information.

Ladybug
In our Head Start program the computer had worked really well with autistic children.

Alyson Beytien
Ladybug, children with autism typically respond very well to computer interaction because it matches their learning style -- visual, concrete, and linear thinking applies. It is always consistent.

IELmoderator
Remember that the IEL Web site is available not only in English but also in Spanish. The Spanish home page is at http://illinoisearlylearning.org/index-sp.html.

Vicki
A new child is enrolling this week. She is extremely oral. Everything goes into her mouth. How do I safeguard her?

Alyson Beytien
Vicki, that's a good question. Lots of our kids are oral. We would certainly like you to take data on when, where, and your best guess as to why the child is putting everything in their mouth. We would typically see it as a coping mechanism and reflective of a need for sensory input. I would recommend you get access to a good occupational therapist who can provide alternative activities to replace the inappropriate behavior. I can post personal suggestions on the transcript. (IEL Editor: Alyson Beytien's suggestions will be available soon.)

Buddy
Is there a way to improve interactions between autistics and their typically developing siblings and lessen the resentment and teasing by the typically developing sibling?

Alyson Beytien
buddy, the struggle to have all members of a family feel "special" when one member requires a majority of time and effort is very challenging. The issues of supporting siblings are very difficult, but not unmanageable. There are a number of curriculums based on supporting the siblings, such as SibShops, that allow the siblings of children with disabilities to get together and share their experiences and realize that they are not alone. Beyond the structured intervention, it is important to let the other members of the family know about the child’s disability in a way that inspires understanding. Many of the siblings of children with autism say that they want to be speech therapists or special education teachers when they grow up because of their interest and desire to help others like their siblings. If possible, setting up a separate time to focus on the other members of the family is really helpful in ensuring that they do not build resentment toward the child with autism.

To further answer buddy's question regarding peer interactions, Our sons have been in an inclusive setting at school since kindergarten, and we have yet to find a child who resents their presence in the classroom or community. In fact, the other children are often our biggest supporters! We believe that the key is knowledge: At the beginning of each school year, I do a presentation to our boys’ classrooms about autism and what they can expect from having our boys in their classrooms. We discuss what the "different" behaviors might be and why our child may be behaving that way. We give time for questions and answers and respond to every question with a factual, real answer. If a child expresses resentment or frustration, we should respond by describing why the child with autism may have acted a certain way and give ideas for how we can react to assist and help.

Todays Child
I have an autistic child at my day care. He is 4 years old but prefers to spend his time with younger children ages 15 months to 2 years. Why would this be the case, and should we let him spend much of the time with the younger children or encourage him to try and spend time with kids his own age?

Alyson Beytien
Todays Child, I would encourage him to spend a larger portion of his day with typically developing peers and use the time with the younger kids as a reward or a motivator for having a positive day in the other classroom.

Vicki
How do I safeguard a child who puts everything into her mouth?

Alyson Beytien
Vicki, that response was given previously and you can view it on the transcript later.

jo
How is PDD diagnosed ?

Alyson Beytien
JO, autism spectrum disorders are diagnosed with a variety of tests specifically for this purpose. PDD is a diagnosis under the autism spectrum disorders. All of the tests use observable behavior along with parent input to determine the diagnosis.

Barbara
Is there any material out there on the connection between early lead poisoning (under age 2) and autism?

IELmoderator
Note that we have a Tip Sheet on "Preventing Lead Poisoning" available on the IEL Web site. This can be found at http://illinoisearlylearning.org/tipsheets/leadpoisoning.htm. This Tip Sheet is also available in Spanish as "Cómo prevenir el envenenamiento infantil por plomo" at http://illinoisearlylearning.org/tipsheets-sp/leadpoisoning-sp.htm.

Alyson Beytien
Barbara, yes, there is some material, but currently the incidence of lead poisoning is small for autism spectrum disorders. You'd find most materials available through an Internet search or through Medline at your local library or hospital library.

IELmoderator
IEL has a series of Chat sessions scheduled through the middle of June. You can view the Chat schedule on the Chat page: http://illinoisearlylearning.org/chat.htm Editor's note: This url has changed: http://illinoisearlylearning.org/askanexpert.htm#pastchat. The next scheduled chat is next week, Thursday, February 27, 7-8 PM Central time. The Chat topic is "Handling Challenging Behaviors in Child Care: Aggression and Anger in Young Children." The guest speaker will be Mary Louise Hemmeter, Director of the Center on the Social and Emotional Foundations for Early Learning (CSEFEL) at the University of Illinois at Urbana-Champaign. You can find information about CSEFEL on that project's Web site: http://www.vanderbilt.edu/csefel.

Dee R.
Why is it that some autistic children are more vocal then others?

Alyson Beytien
Dee R., we really don't know the answer at this point. I can tell you that in my own home, two of my three boys with autism are highly verbal, and one is basically non-verbal.

tay
We have a child in our class who comes into our day care saying that he hates his parents. Is reverse psychology a good thing to use with him?

Alyson Beytien
tay, no, I would not recommend it. Remember that children with autism are literal thinkers and he is probably mimicking a cartoon or movie phrase that he heard. I would instead recommend that in a calm moment with the child you teach a more appropriate phrase to use when he is angry with his parents.

V.J.
What is a good resource for parents to read on autism?

Alyson Beytien
V.J., the Illinois Autism Training Project has a lending library of over 60 books, videotapes, and manuals related to autism. The library locations are available on our Web site (http://www.theautismprogram.org) along with the listing of everything available. You can peruse it by topic, and I would first look under "basics."

IELmoderator
IEL produces a series of Tip Sheets, short, informative pages on topics of use to parents and caregivers in Illinois. You can visit the Tip Sheets page on the IEL Web site: http://ecap.crc.uiuc.edu/cgi-bin/iel/searchiel.cgi?action=searchieltips. The Tip Sheets are also available in Spanish as "Paginas de Consejos."

Some recent Tip Sheets added to the IEL Web site are the following:

Additional Questions

V.J.
What are the most prominent signs of autism?

Alyson Beytien
Most parents see the language delay and unusual behavior as the most prominent signs of autism. Research is showing, however, that the lack of social skills can be observed as early as 8 months of age with almost 90% accuracy. As parents, we don't really expect too much social interaction until the age of 2 or 3, though, so it would be unlikely that we would pick up on that sign.

V.J.
What's the best age to detect autism?

Alyson Beytien
Ideally, 18-24 months of age. The earlier we notice something is different in the child's development, the sooner we get intervention. Early, intense intervention is the key to helping the child. Of course, we'd like to get some kids earlier if possible, but it is not typical to see them earlier than 18 months.

VLTandGOD
I'm a child care provider and have a child in my class that has characteristics of autism. How can I be sure? The child is 2 but not ready to move to our toddler room. His mom knows something's not right but is concerned he'll be labeled retarded.

Alyson Beytien
I would encourage you to talk with the mom about the importance of early intervention no matter what the actual diagnosis is. We often have children with a "developmental delay" that receive services by the age of 2, and maybe within a service setting, the mom would feel more supported to pursue a more defined diagnosis. Also, it was previously believed that about 80% of individuals with autism were mentally retarded. But we now believe that only 25% are actually mentally impaired. The difference is that we understand that they can communicate and want to. So we are seeking out better ways to understand how they think and communicate.

Carolina
Beginning next week, I will be a one-on-one aide to a child with autism. Do you have any advice on how to help him in the best way possible?

Alyson Beytien
First, let me thank you for being an assistant to this child! I would recommend that you do a bit of reading and research on autism, and especially read How to Be a Paraprofessional by Diane Twachtman-Cullen. The short answer beyond that is to respect the child, remember that he/she wants to communicate with you, and find any way you can to provide structure and security to him.

pazbo
Do you think that there is a link between autism and the children's vaccinations? My son was a normal baby and was starting to talk, and after his 18-month shots he slowly started regressing and than stopped talking altogether!

Alyson Beytien
There is a large group of parents and professionals that believe there is a link between vaccines and autism. Nothing has been proven at this point however. Research is moving forward on this theory, however, along with some other theories of causation also. Many books on autism address the various theories of causation, but my personal favorite is by Lynn Hamilton: Facing Autism.

Question
What is the latest information linking diet and autistic behavior?

Alyson Beytien
The answer to this question is very long, so let me provide you with some resources to go to. Any number of Web sites will handle this, so a search on "autism diet" on the Web will give you a lot of info. There are now lots of books on the subject also -- Special Diets, Special Kids; The Autism Treatment Guide; and others. Just remember that currently, nothing has been proven, and it is up to us as parents to decide if the protocol matches our child or not.

Question
What kinds of early childhood settings seem best suited for children with autism: Small, family child care settings? Larger, center-based settings? Mixed-age groups? Or single-age groups?

Alyson Beytien
Current research has shown us that the key elements to a child with autism progressing and learning are having some part of their educational day spent interacting with typically developing peers and some part of their day spent in one-to-one teaching for intense learning and skill building. This can be done in a variety of settings with a variety of ages. But our children learn by watching the world around them, and they need structured opportunities to watch typical peers communicate, learn, and use appropriate behavior with others.

Question
What problem behaviors are more often found in autistic children than in other children?

Alyson Beytien
I have to reiterate again that "problem behaviors" are often a means to communicate a want or need. Typical children do this with gestures or verbal language. If neither of these skills is currently accessible by the child with autism, the child may resort to using unusual and challenging behaviors.

Our kids with autism are often in sensory overload also. They struggle to process all of the sounds, movement, lights, tastes, textures, and sights of our world. A "problem behavior" can also be the result of a sensory problem and can be modified with an appropriate sensory diet.

In our family's experience, we have had everything from aggression to peeling wallpaper off walls to shattering glasses to stripping naked at the top level of the Burger King playland! For parents, it is important to remember that these behaviors are often stages, and you may never know what behavior will be next! Sometimes, the one we had before was better than the next one!

Question
Are there teaching techniques that may lower the incidence of challenging behaviors in autistic children?

Alyson Beytien
Visual, visual, VISUAL! Our children are typically visual learners. If we want them to complete a task, communicate a need, or handle a change in schedule, we need to make it visual for them. Visual systems are really the key to lowering challenging behaviors because they allow the child the ability to understand you, and you the ability to understand them!

When we started a picture communication system with our son at 2½, he had some very challenging behaviors -- lots of screaming, throwing things, hitting, etc. Within 2 weeks of beginning to use a structured, consistent teaching of a picture system, we noticed that his challenging behaviors had gone way down. It has also been shown that kids who are given another form of communication early on in life actually use verbal language earlier than others. We have found this to be true in our family: The use of a picture system increased their use of actual verbal language.

Question
How can we help children with autism improve their interaction with peers?

Alyson Beytien
Structured, concrete interactions with lots of support can help. Start with small groups -- maybe only one peer, participating with the child with autism in an activity that they both have already mastered. There should be lots of visual systems to support the child in communicating. And there should be lots of support for the typical peer in his or her efforts to interact!

Our youngest son, Zachary, struggles with lots of autism. We have been working on his interaction with peers at school for 2 years now. Initially, our goal was to get him to sit at a table with a peer and say hello. His teacher told me that the other day, he played "Barnyard Bingo" with 3 other typical peers for about 20 minutes, taking turns and waiting appropriately! Wow! Now this took a lot of work on his teaching team's part, but he loves it now!

Question
How can a classroom be arranged to better accommodate an autistic child?

Alyson Beytien
I'm afraid my answer is the "VISUAL" word again. Can you walk into your classroom and, just by looking at it, know what tasks are to be accomplished in what areas? Is it structured in such a way that it promotes learning without always needing an auditory instruction? Are areas clearly labeled with words that match the child's schedule? Is it too visually stimulating because the walls are covered with all the latest posters and educational knickknacks? Our kids with autism will do much better in structured, organized environments.

That doesn't mean sterile. It just means that we should be able to move logically and clearly through the space.