10 tips from Sue Larkey’s seminar.

I recently attended Sue Larkey’s seminar on Teaching Strategies and Behaviour Support. Here are 10 tips that she covered in the seminar:

1. Not all strategies work for every child, and not all strategies work all of the time. If it’s not working, move on and try something else

2. No=never. The word “no” can trigger a meltdown. If you say no, and you mean not now, don’t say no. You say no, they hear “never”. A day after the seminar my son illustrated this very point. He was writing his grandad’s birthday card. He couldn’t fit the whole of a word on one line so I told him that he could use a hyphen and finish the word on the next line. He got very upset and wanted to scribble the word out and start again. When I asked him why he told me his teacher said that he wasn’t allowed to split the word up. So he applied that rule to all situations.

3. You cannot stop a behaviour. Each behaviour serves a function, so replace the behaviour with another behaviour. For instance if a child constantly chews their clothes, replace this with a sensory toy designed for chewing. This will help the child stay calm and concentrate. To just stop them without replacing the behaviour with an alternative will cause the child anxiety and make matters worse.

4. A sensory meltdown is different to a behaviour meltdown. There is no warning and it strongly triggers the fight or flight mechanism in the brain. It is a catastrophic reaction to social or sensory experiences. If they run and don’t look back it is sensory and no amount of rewards or bribery will work with them. They need comforting or solitude until they calm down. Don’t tell them to calm down as the meltdown may escalate, or ask them what’s wrong as they can’t tell you. A behaviour meltdown is different as it is a response to frustration, and will often end with emotional blackmail (!). The child is assertive and calm during this time. If you are unsure of difference, Sue says, look in their eyes.

5. Children on the spectrum are often multisensory or kinaesthetic learners (also called tactile learners) and respond to multisensory and hands on learning. They often concentrate better while playing with a fidget toy or moving around. They also respond better to rote and repetitive learning, and not problem solving learning, which schools have been moving towards.

6. Their intellect is their vanity. They may have the ideas and have done the work in their head, but may be slow to put onto paper. Do not humiliate them by telling them they have done no work. Get someone else to be their scribe or use Dragon software

7. Some children with ASD have a “veneer of coping” during school or social events. They are exhausted trying to be good, social and jovial, but when they get home they just want to relax and unwind. If any demands are put on them during this time, they may go into meltdown. This can be a problem when homework is expected.

8. During school, their should be a ratio of 25 minutes schoolwork, 5 minutes of special interest. This will serve as a reward, but also allows them to relax and refresh before moving on to further school work. At home, home is for relaxation so the ratio should be 25 minutes relaxation to 5 minutes work or chores. But for those children who have a veneer of coping, homework may be a step too far, so maybe an arrangement can be made where they do homework at school.

9. When children know the routine and are relaxed, you don’t always need to continue using all strategies all the time. Use common sense when to use and when not to.

10. Consequences do not work for children on the spectrum.

Synaesthesia

Glowing Green Bubbles Water Drops by Madartists! Dreamstime.com

It seems my extreme empathy may be down to a condition called Synaesthesia, and more specifically something called Mirror Touch Synaesthesia. Before I go into this in more detail I would like to talk a little more about Synaesthesia in general. Synaesthesia is a cross processing of the senses. Although it can affect neurotypicals, a great many people on the autism spectrum have it. Many great composers and artists, wine tasters and memory champions often have it and it gives them a unique talent not shared by everyone. It seems, as with autism, that there are a few different genes that could be responsible and it will often run in families. See link

In addition to the extreme empathy, my own Synaesthesia manifests itself in a couple of ways, I hear colours (which I also associate with words) and when I feel textures it has a strong emotional influence on me, see Tactile Emotion Synaesthesia.

I hear colours in music which does a lot to dictate my musical tastes. I love orchestral heavy metal as it has lots of warm vibrant colours, whereas Rn’B leaves me cold as it is full of insipid blues and greys. Words and letters bring up colours in my head, which helps my memory, especially for spelling. For instance, A is yellow, B is blue, C is red, D is orange, E is green etc. Words containing those letters may have associated colours, but do not always take the colour of the first letter. “Everybody” and “Everyday” are green, probably because of the dominance of the letter E, whereas “Day” is yellow because of the A and “Dog” is yellow and white, mainly because of the O and G sound. Monday is white, Tuesday is yellow, Wednesday is orange, Thursday is navy blue, Friday is black etc. I remember the day of a meeting or appointment by recalling the colour associated with it.

The Tactile Emotion Synaesthesia influences the clothes that I prefer to wear and means that I am very uncomfortable in certain clothes. This makes clothes shopping difficult and time-consuming and I can only do it when I am relaxed.

Mirror Touch Synaesthesia can be a blessing and a curse. In some respects I can imagine what a particular thing must feel like so it keeps me away from dangerous situations. It allows me to imagine what someone must feel like, allowing me to put myself in their shoes. This could be the basis of the Intense World Theory. This would be a fantastic advantage for an actor and it is possible that some of the most charismatic actors may indeed have this ability. But it also means that when someone hurts themselves I flinch, rather than speeding into action to help them. It paralyses me for a few seconds and I have to force the feeling out of my mind.

There are many kinds of Synaesthesia and researchers believe that many of us have it to a certain extent, but to some it governs their lives, in both positive and negative ways. I love having Synaesthesia, but it means that I can be very  inflexible, and also respond differently in traumatic or emotionally charged situations . One of the leading researchers in Synaesthesia is Simon Baron Cohen from the Autism Research Centre, Oxford, UK, the man behind the AQ test.

See also link

Post Script: since I wrote this I have also noticed that certain colours make me feel cold.

Tips for School

I went to seminar given by Tony Attwood and Michelle Garnett, presented by Sue Larkey. They had some great tips to help children at school, so I thought I’d share them for any teachers or aides, or even parents whose children may be finding school a challenge. This may also help them with homework as well as in the classroom.

It is often difficult for children with ASD (Autism Spectrum Disorder) and Aspergers to start a task and they often can’t finish it in time. To assist them in this, allow them to mark the questions that they can do in green, the ones they need help with in orange, and the ones to leave for later in red. This way they can start the task with the questions that they find easiest and gain momentum. Often they will feel compelled to finish the whole task. In fact, they may get distressed if they haven’t finished the task they are on before it is time to move on. In this case Sue Larkey advised to put in a marked box for completion later if they run out of time. Designate another 10 minutes later for them to finish.

Tony and Michelle talked about errorless learning. Children with ASD and Aspergers are perfectionists – they want to not make errors and will often get upset or have a meltdown if they make a mistake. Understanding this can help them. Set a realistic task they are likely to complete. Help them finish. Maybe do half each e.g. you read one page, get the child to read the next.

Some days are worse than others. On a bad day give revision rather than new material, Make it achievable. Tony and Michelle said that Aspergers behaviour is often cyclical. i.e. bad days may be predictable to a certain extent. For this they suggested keeping a diary to see if a pattern emerges.

Praise success, focus on when the child is correct. If they struggle, move on to next question or task and try again. Work on gaining a momentum of learning and success. They thrive on success. Always be positive.

Their primary motivator is not pleasing the teacher or their parents, although they will often get upset after the fact if they have let them down. Encourage their intellectual vanity. They take pride in their intelligence!

Use their special interest in the classroom to teach a range of things. For instance, if a child’s special interest is trains, this can be used to teach geography, history, science, maths etc. Children with ASD like to collect facts, so this is a useful resource to tap into. Solitude and special interests are the “cure for Asperger’s”. These children will often engage more, have better social skills and more frequent eye contact when exploring their special interest.

Focus on relaxation and pleasure. These can lead to an economy in teaching, extending their special interest. If special interest goes dark however (eg an interest in weapons), this may be sign of depression.

Create a “workstation” – a distraction free zone, that anybody can use so the child with ASD isn’t singled out, but they have somewhere to go if it all gets too much and they can’t concentrate.

Teach them how to use lists.

Use visual timetables and schedules to help with their organisation skills (see do2learn)

Fast ForWord

Fast ForWord is a program that was developed following the discoveries by neuroscientist Michael Merzenich and his colleagues at the University of California and Rutgers University.

It is designed to address auditory processing difficulties using distorted speech sounds and tones. Many of the speech sounds use commonly confused phonemes and train the user to differentiate between these. There are various levels of the program available, ranging in complexity from basic to advanced based on the user’s age and abilities, from preschool upwards. They have found favourable results for those with a mild to moderate APD, and can often assist with reading difficuties associated with Auditory Processing.

http://www.youtube.com/learnfasteducation#p/u/9/WulFNyBnAAQ

The Fast ForWord provider in Australia

http://fastforword.rtrk.com.au/?scid=25593&kw=4283543

Brain Science of Aspergers and Autism Pt. 4: Mirror Neurons

Mirror Neurons are the cells in the brain that allow you to feel empathy, to put yourself in someone else’s position and understand how they are feeling. It is why a smile can be contagious. Mirror neurons are the reason we flinch when we see someone get hurt, we can imagine it happening to ourselves, we know what it feels like even if we have never been in this situation.

James R Hurford, of the Linguistics Department at the University of Edinburgh defines a mirror neuron as a neuron (nerve cell) which fires both when performing an action and when observing the same action performed by another creature. Quizlet.com tells us that mirror neurons are important for “understanding actions of others (empathy, interpretation, non-verbal communication)”, which traditionally children with Aspergers and Autism have difficulty with.

Mirror neurons are also important for learning new skills, especially motor skills. A child will observe a parent engaged in a behaviour, and they will often instinctively imitate. A lack of imitative behaviour can be noted in some children with ASD (Autism Spectrum Disorder).

It has been hypothesised that people with Aspergers and Autism have a lack of mirror neuron activity (1). Most neuroscientists acknowledge that there is a dysfunction in the mirror neuron system.

When I think about my own experiences and look at my son, I believe that we do have mirror neuron activity, especially when it comes to observing pain in others. So I decided to look into this further.

Neuroscientists Lindsay M. Oberman, Edward M. Hubbard, Joseph P. McCleery, Eric L. Altschulera, Vilayanur S. Ramachandrana, Jaime A. Pinedad have done a series of studies into the role of the mirror neuron system and its link with autism.

They have discovered a dysfunction in mirror neuron activity in the sensorimotor cortex, which is involved in observing and imitating motor (movement) behaviours.  This study was undertaken with 10 males with ASD and another 10 males without as control subjects, it is not clear what ages these subjects were. A further study by the same authors discovered that the earlier observed mirror neuron dysfunction was not the case when observing familiar individuals such as family members:

“In conclusion, this study finds that the observation of actions performed by familiar individuals results in mu wave suppression [reduction in brain wave activity from the neurons] in individuals with ASD, while the actions of strangers do not. This is the first study to show normal mu wave suppression during action observation in individuals with ASD. The observation that the MNS [Mirror Neuron System] in ASD may be functioning normally under specific circumstances bodes well for therapeutic interventions aimed at improving social deficits in this population. Perhaps if one could improve the ability in children with ASD to identify with the observed unfamiliar person through behavioural, neurofeedback, or other types of training, one might improve the functioning of the MNS and alleviate some of the behavioural deficits associated with this disorder.”

The Autism Coach website has an article which discusses Mirror Neuron theory and the studies by Oberman, Ramachandrana et al and states:

“The researchers speculate that mirror neuron system may also account for the tendency of autistic individuals to interpret figures of speech literally. Which part of the human brain is involved in this skill of developing overall cognitive maps of understanding from diverse information coming from multiple sensory sources? The angular gyrus, which sits at the crossroads of the brain’s vision, hearing and touch centres, seemed to be a likely candidate because nerve cells with mirror neuron-like properties have been found there. Nonautistic subjects with damage to the angular gyrus have difficulty understanding metaphors, as do many people with autism.”

It goes on to say:

“The discovery of mirror neuron deficiencies in people with autism could be used as an early diagnostic tool.  Physicians could use the lack of mu-wave suppression as a diagnostic tool to identify children with autism in early infancy, so that  therapies can be started as quickly as possible.

The researchers also suggest that biofeedback might used to display the mu waves and then use visual feedback of the display of the mu waves to teach children how to suppress the mu waves, just as biofeedback is used enable people to manifest other brainwave patterns.  A researcher, Pineda, is pursuing this approach, and his preliminary results look promising.

Another approach is to correct chemical imbalances that disable the mirror neurons. These researchers hypothesize that specialized neuromodulators may enhance the activity of mirror neurons involved in emotional responses. According to this approach, the partial depletion of such chemicals could explain the lack of emotional empathy seen in autism, and therefore researchers should look for compounds that stimulate the release of the neuromodulators or mimic their effects on mirror neurons.”

The author of the article gives personal experiences and suggests ways that this knowledge could help a child in the classroom.

The Mirror Neuron theory backs up my own observations over the years that the best (and usually only) way to teach my son within the autism spectrum has been to have him do the task himself.  I have found that standing behind him and using my hands to guide him through a new task was often the fastest, most effective way to teach a new skill.   Demonstrating or lecturing was almost always ineffective.  This research has wider educational implications, leading to the logical conclusion that the  typical public school model of children learning from an instructor lecturing up at the front of a room would fail to teach an autistic child.  An autistic child in a traditional classroom would be likely to be bored, frustrated and unable to learn.  However, these same children can learn if they are guided to carry out the actions of the concepts being taught, as is done in teaching them the acquisition of language through therapies such as Applied Behavioral Analysis.  This understanding of how children within the autism spectrum learn could completely redefine what constitutes an appropriate education for autistic children and best practices for teaching them in the public schools.”

Another study by Dapretto, Davies et al discovered that “high-functioning children with autism showed reduced mirror neuron activity in the brain’s inferior frontal gyrus (pars opercularis) while imitating and observing emotional expressions”, which could explain why people with ASD have more difficulty recognising emotion in facial expressions. Their study used 9 male children with ASD and 9 controls.

But there is hope for the person with ASD. Recently it has been discovered that rather than there being a lifelong dysfunction in the mirror neuron system, that it may just be delayed in developing. In an article published in Biological Psychiatry the author suggests that the mirror neuron system develops over time:

“Dr. Christian Keysers, lead author on the project, detailed their findings, “While most of us have their strongest mirror activity while they are young, autistic individuals seem to have a weak mirror system in their youth, but their mirror activity increases with age, is normal by about age 30 and unusually high thereafter.” This increase in function of mirror neuron systems may be related to increased capacity for social function or responsiveness to rehabilitative treatments among individuals with autism. The finding of late developing circuit functions could be very important. One wonders whether the recent breakthroughs in the genetics of autism could help to identify causes for the developmental delays. This type of bridge might help to identify novel treatment mechanisms for autism,” said Dr. John Krystal, Editor of Biological Psychiatry. One of the next steps in this line of research will be for researchers to examine how individuals with autism accomplish this improvement over time, and how therapeutic interventions targeting the same mechanism can help to support this important process.” (2)

It is also possible that only certain areas of the Mirror Neuron System are affected. More study is needed.

Christian Keyser on mirror neurons

References:

(1) Brain Rules for Baby by John Medina
(2) scienceblog.com

Emotions and Cognitive Behavioural Therapy

There are a few products on the market designed to help a child with Aspergers or Autism with emotions. The CAT kit developed by Dr Tony Attwood is designed to enable a child to recognise their own emotions and to gain control their emotions and behaviour.

Professor Simon Baron-Cohen of the University of Cambridge has developed a program called Mind Reading, which is available as a DVD or CD-ROM, or as an audio book. He explains his research that led to the development of Mind Reading here.

We’d love to hear from you if you have a review of either of these products. You can comment at the bottom of the page or email kidsplorers@gmail.com.

 

Brain Science of Aspergers and Autism Pt. 3: Learned Safety

Eric Kandel, in his book “In Search of Memory”, tells us that positive emotions appear to be processed in a different area of the brain to negative emotions such as fear or anger, which has the effect of inhibiting the amygdala, which is often activated when a child with Aspergers or Autism is having a meltdown or feeling afraid. This could explain why in stressful situations they calm themselves down with certain behaviours, be it repetitive actions, rocking or cuddling a toy.

Kandel’s studies show that by doing something that  is associated with safety, it activates a part of the brain called the striatum, which is involved in positive reinforcement and feeling good. This has the knock-on effect of activating areas in the prefrontal cortex, which inhibits the amygdala, thus inhibiting the anger or fear response.

This seems to me to be a weapon in our arsenal to calm those strong anger or fear responses, whether this is by having a familiar toy to hold onto, or a safe familiar place to retreat to in times of extreme negative emotions.

Brain Science of Aspergers and Autism Pt. 2: Anger and emotion

It is generally accepted that in Aspergers Syndrome and Autism that there is some abnormality in a primitive area of the brain called the amygdala. The name “amygdala” means almond, and there are two almond shaped structures buried deep within the medial temporal lobe. These form part of the “limbic system”, which is responsible for generating and modulating emotions, and laying down long term memories. The role of the amygdala is to coordinate information from different parts of the brain and generate the emotion.

Emotions are a response to bodily changes e.g. feeling hot, tense, sweating, or going red. The amygdala receives sensory information about a situation and the bodily changes from the nervous system, and everyday experience confirms or dismisses the threat accordingly. It is far better to interpret a stick as a snake and respond accordingly only to find out it was really a stick, than for your brain to think about it and get bitten before you realise what is going on.

According to neuroscientist Eric Kandel, emotion, such as fear and anger, has two components, conscious and unconscious. The amygdala receives information from both unconscious and conscious pathways when the brain perceives a threat.

The unconscious component of emotion is the operation of the nervous system. The stimulus is then analysed and an area of the brain called the hypothalamus regulates the emotion.

The conscious component of emotion involves evaluative functions of the cerebral cortex (the area responsible for planning, attention, language and reasoning), and the hippocampus, which is responsible for long term memories and the memory of emotion.

Central to both is the amygdala. According to Kandel, the amygdala is thought to coordinate the conscious experience of feeling and the bodily expression of emotion, particularly fear. It is also the area responsible for triggering the “fight or flight” response.

It seems that in the brain of someone with Aspergers or Autism that the amygdala is triggered on the unconscious component of emotion. It is possible that the brain misinterprets a stimulus as threatening, possibly due to Merzenich’s undifferentiated brain maps. When the person is in this state, logic and reasoning don’t work, and they are not necessarily aware of why they feel so angry or afraid. It appears that something in this system is not working correctly. It is understood that they have an abnormality in their amygdala, but there may also be other factors at work here, such as malfunctions in the pathways to the parts of the brain that analyse the emotion.

Cognitive Behavioural Therapy is often recommended to assist a person with Aspergers or Autism in the controlling of their emotions. Often the therapist will use a visual aid such as a “thermometer” to allow the person to recognise the bodily changes described above, before the amygdala sends the message to release the hormones associated with the fight or flight reflex. It also allows them to consciously analyse their emotions. Tony Attwood has a CBT program that he has developed; further information can be found here.

Once the emotion is triggered, it is impossible to reason with the person with Aspergers, so it is best to leave them to safely calm down, or to distract them. Tony Attwood advises using their special interest as an effective distraction, or maybe giving them a sensory toy to play with.

It seems that traditional methods of meditation and relaxation do not work with someone with Aspergers. Tony Attwood notes that they prefer to be active or physical or to do something repetitive, or even listen to music of their choosing, probably very loudly and over and over again.

References: In search of Memory by Eric Kandel, The Complete Guide to Asperger’s Syndrome by Tony Attwood, The Emotional Brain by Joseph Le Doux

No single cause for ASD?

Francesca Happé, Angelica Ronald and Robert Plomin at the Institute of Psychiatry, Kings College London, believe that it is time to give up on the search for a single cause of Autism Spectrum Disorder, that many genes could be responsible for separate traits on the autism spectrum. Read their paper here

Autism Spectrum Disorder and Fragile X link?

Neurorocker at en.wikipedia

 

When I started to really dig into the genes behind Aspergers and Autism, it seemed that it isn’t as clear cut as I initially thought. After researching the brain science of Fragile X syndrome (and the FMR1 gene) to establish how it could cause Autism and Aspergers, I discovered that that there isn’t just one gene that causes ASD. It seems there may be a range of genes, all of which seem to have similar effects on the developing brain.

In this post I shall discuss the FMR1 gene that causes Fragile X syndrome and its link to Autism.  Fragile X Syndrome is so called because a small section of the genetic code is “repeated on a fragile area of the X chromosome” (source PubMed Health)

According to the National Fragile X Foundation:

“FXS is the most common known cause of autism or “autistic-like” behaviors [sic]”

“Fragile X syndrome can cause a child to have autism or an Autism Spectrum Disorder (ASD) though not all children with fragile X syndrome have autism or an ASD.

  • FACT: For between 2% and 6% of all children diagnosed with autism, the cause is the Fragile X gene mutation.
  • FACT: Approximately one-third of all children diagnosed with fragile X syndrome also have some degree of autism.
  • FACT: Fragile X syndrome is the most common known single gene cause of autism.”

The A.D.A.M. Medical Encyclopedia notes that the symptoms of Fragile X are very similar to those with Autism:

  • “Delay in crawling, walking, or twisting
  • Hand clapping or hand biting
  • Hyperactive or impulsive behavior
  • Mental retardation
  • Speech and language delay
  • Tendency to avoid eye contact”

The reason Fragile X caught my eye is that one of the most common symptoms or signs of Fragile X is the hypersensitivity to sensory stimuli, as outlined by an article in Science Daily:

“New research provides insight into why fragile X syndrome, the most common known cause of autism and mental retardation, is associated with an extreme hypersensitivity to sounds, touch, smells, and visual stimuli that causes sensory overload and results in social withdrawal, hyperarousal, and anxiety. The study, published by Cell Press in the February 11 issue of the journal Neuron, uncovers a previously unknown developmental delay in a critical brain circuit that processes sensory information in a mouse model of fragile X syndrome.”

This is consistent with my view that the majority of symptoms associated with Autism and Aspergers are caused by sensory overload. In response to this article the Shared Attention website notes that: “This seems to support so-called experimental therapies (e.g. sensory integration) that theorize that plasticity in sensory processing can afford lasting positive changes in neurological function and behavioral outcomes. In other words, by using natural interests of the child to harness their attention and engagement, it may be possible to use purposefully engineered activities to modify and naturalize those pathways”.

And it seems that treatment for a child with Fragile X is similar to those with Autism and Aspergers. Source: Medicine.net:

  • Know the learning style of the individual.
  • Develop a consistent daily schedule or routine.
  • Use visual signs (pictures, sign language, logos, words) and concrete examples or materials to present ideas, concepts, steps, etc.
  • Prepare the individual for any changes in routine by explaining them ahead of time, possibly using visual signs.
  • Include functional goals with academic goals; for instance, teaching the individual the names of different pieces of clothing as well as how to dress him/herself.
  • Provide opportunities for the child to be active and move around.
  • Use computers and interactive educational software.
  • Provide a quiet place where the child can retreat and regroup.

So how does the Fragile X gene lead to symptoms similar to Autism?

This from the A.D.A.M. Medical Encyclopedia.

“Normally, the FMR1 gene makes a protein needed for your brain to grow properly. A defect in this gene makes your body produce too little of the protein, or none at all.” The link between the FMR1 gene and the hypersensitivity displayed in Aspergers and Autism has been established (see academic paper)  . The nerve cells in the brain initially grow extra branches, which could explain the hypersensitivity to various sensory stimuli. This could lead to the premature turning off of the “critical period” as discovered by Merzenich. The nerve cells eventually “prune” the branches so that the nerve cells appear normal, but at this stage it could already be too late, as the brain is left with the “undifferentiated brain maps” discovered by Merzenich.

According to the A.D.A.M. Medical Encyclopedia:

“Boys and girls can both be affected, but because boys have only one X chromosome, a single fragile X is likely to affect them more severely. You can have Fragile X syndrome even if your parents do not have it.

Fragile X syndrome can be a cause of autism or related disorders, although not all children with fragile X syndrome have these conditions.”

The symptoms are more likely to be pronounced in boys, girls may only exhibit behaviours such as shyness.

But the FMR1 gene cannot be the only cause of ASD. The main issue with this as an umbrella answer to ASD is that males with Fragile X cannot pass it onto their sons, due to the fact that they only transmit the Y chromosome, and not the X. (source: Autism Help)  But it seems that many boys with Aspergers and Autism have a father who also has it. In addition the IQ of a person with Fragile X Syndrome is highly likely to be below average, although this is not always true for girls. Although the research in this area may be slightly inaccurate, as medicine.net points out:

“Attention disorders, hyperactivity, anxiety, and language processing problems can interfere with test-taking skills and learning. Because many people with Fragile X have these problems, a person with Fragile X may have more capabilities than his or her IQ score suggests”

So the search for the common cause continues…

Academic Papers on Fragile X:

http://www.fragilex.org/pdf/kaufmann-et-al_autismandfragileX.pdf

http://www.ncbi.nlm.nih.gov/pubmed/19441123