Establishing eyecontact

by Angela Mouzakitis, BCBA

Eye contact for children with autism is always a concern. Well, not always, but usually. I do work with one little boy that appears to love looking people in the eyes and teaching this skill took all of four days when he was two-years old. For the rest of our kids, it can be very challenging.

Different orientations go about teaching eye contact in various ways. While I've voiced my opinion on RDI in the past, I will discuss it as additional strategies here. But in summary of previous posts, behavior is behavior. If you want to teach a new behavior, like eye contact, it WILL be taught using behavioral principles, whether you are comfortable calling it that or not. RDI provides us with strategies that modify the environment and provide creative ways to elicit eye contact, but eventually that eye contact is reinforced (ABA) shaped (ABA) given differentiated reinforcement depending on quality of eye contact (ABA) elicited by modifying the environment (ABA) elicited by using a discriminative stimulus (ABA). It is all ABA.

Where ABA has fallen short on the eye contact issue, in my humble opinion, is by not exploring more creative methods to elicit eye contact, and to make giving eye contact important. I'll go over some traditional methods that have been used to elicit eye contact, and then how some RDI ideas can be incorporated into an ABA program (since they are all based on behavior principles anyway.)

DTT - Discrete Trial Instruction/Training programs tend to teach eye contact in very contrived situations. A child will sit opposite a therapist, and given the directive "look at me" or the child's name will be called. Depending on the level of the child, a reinforcer will be held at the teacher's eye to help the child understand where they should look. Contingent upon eye contact, the child will immediately receive the reinforcer, possibly providing a token, and providing praise. It make look like this.
Teacher: "Look at me" (while holding an M&M at her eye)
Child: Looks at M&M and glances at teachers eye
Teacher: "Excellent looking" and provides M&M immediately.

This is an effective method and will teach a child to look at someone at the eyes when a demand is placed, when their name is called, when a reinforcer is present. However it doesn't always generalize. Some children that I work with look at me beautifully in the eyes, but when their grandmother says hello, they are looking anywhere but her eyes. Why? Maybe because she is not holding an M&M or a reinforcer in her hand, so the MO (motivating operation) to look in her eyes is not there. The child has not generalized that looking at people in the eyes is reinforcing.

ABA - Applied behavior analysis will of course incorporate the strategies used above, slowly fading out the item at the eye, just like DTT, until the child looks at the teacher's/parent's eyes without have a reinforcer within eye sight. Other methods are always used. In my programs, I prefer not to demand eye contact, but rather to wait for the child to initiation eye contact and reinforce the spontaneous eye contact. An example of this is the following

Teacher: Holding Elmo toy that two-year-old child with autism clearly wants to play with.
Student: Pulling at the toy, while staring at the toy
Teacher: Teacher looking at child's face, not letting go of the toy
Student: Still pulling at toy
Teacher: Still holding toy....continues to hold on until child glances up at which point the toy is immediately provided with praise and excitement.

This method reinforces spontaneous eye contact as opposed to eye contact that is requested. What ABA therapists do is contrive the environment to elicit eye contact, and reinforcer the eye contact, assuring that future eye contact will occur at higher rates due to the reinforcement.

RDI? I don't think RDI strategies are inconsistent with applied behavior analysis (ABA). What I have learned by attending these seminars is how to be more creative with my children. How to give my a children cool reasons to look at me, give me eye contact and enjoy themselves while doing it. It is these cool creative ideas (reinforcing events) that when used in the environment (modifying the environment) will provide a stimulus (SD) to elicit eye contact (response). (Do you see how it all falls so nicely into behavior principles.

I tried some of these strategies with a child that I work with. RDI talks about doing the unexpected, getting creative, and making kids care about giving eye contact. Now, I don't know if I am making them care about giving eye contact as it isn't something that I can observe, but what I CAN do is note the response, which was fantastic, and it didn't include reinforcing objects, rather reinforcing people (myself). That is one of the core tenets of RDI: to keep objects out of it and build relationships with people, which is quite different from ABA and DTT which rely on tangible reinforcers heavily.

I sat opposite a five-year old child with autism, removed toys and reinforcers out of sight in the environment, I positioned myself in front of him and waited. He didn't look at me, save the occasional glance. When he would glance, I smiled. See below

Child: Glanced
Teacher: Smiled
Child: Glanced again
Teacher: Blew air in his face
Child: Giggled
Teacher: Waited for eye contact again
Child: Gave it much more quickly
Teacher: Pinged child's nose
Child: Giggled, and while maintaining eye contact, blew air in teachers face
Teacher: Giggled, and made a raspberry on his cheek
Child: Giggled, and laughed, and said "blow"
Teacher: Blew air in his face, then by his ear, then on his toes
Child: Giggled, and pinged teacher's nose.

This went on, while maintaining eye contact. This is not an RDI program, this is an ABA therapist, using some of the creativity from RDI, and reinforcing and shaping the eye contact behavior of the child. At the end of this interlude, before he got tired of the game (satiated) I laid down on my back and left him alone. Normally, he would have walked away and found a toy to stim with. This time, that didn't happen. He watched me lay down, walked over to my face, looked at my eyes, giggled, and blew air at my cheek. I had made my eye contact and interaction reinforcing to him, so much, that he was seeking it out.

Source: http://appliedbehavioranalysis.blogspot.com/2007/08/eye-contact-aba-dtt-and-rdi.html

Parents sharing experiences with eachother

For a parent with a special child life may see very indifferent and challenging. Because of this, it is always good to be in a support group where you can share and learn from other parents who are in the same boat.

If you are in the Maldives and looking for such a group try out with MvDisability (Maldivian Disability Support Group). Their website is http://mvdisability.siph.net/ Since autism has not been a national issue so far, there is no specific similar group for autism in the country. You can also view updates on the group from this link.

Having thought about the importance of sharing throughts with others, a new feature -- a webchat -- has been added to this webblog to enable visitors to interactive with eachother. We hope our visitors would make the best use of it.

Who are we?

This is an interest group setup with the following objectives:

1. To educate the Maldivian society on autism, a developmental disorder affecting speech, social skills and behaviour;
(We aim to eduate the society on how to identify the symptoms of autism sothat parents can consult a concerned professional (a psycholigist or psychiatrist or a developmetal peadiarician) for a diagnosis before it is too late. While doing this we will discourage the society from labelling a child as autistic and feel indifferent towards him or her. On the contrary, we wish to make the society understand the need to be helpful and supportive towards them by providing information on how to treat such children and where the treatments or therapies are available.)

2. To voice the need for the establishment of diagnosis facilities throughout the country sothat intervention/therapy can be pursued as early as possible;
(Our understanding is that at present there is no means for parents to carry out a formal diagnosis on autism within the country, even if they wish for it. We should understand here that obtaining a formal diagnosis is not the best you can do for your child, but beginning an early intervention program or treatment for your child immediately after it, as success rates are high with those child who begins intervention/therapy at an early age.)

3. To voice the importance of establishing early intervention facilities/centres at the health institutions and elsewhere within the country; and
(We should understand that only a small number of families can afford to get treatment for their children overseas. So, early intervention facilities and scientifically proven therapies must be made available within the country and should be readily available at the local health institutions like other types of treatments. If not, the government must provide opportunities for these children to obtain treatment at affordable rates from places where they are available.)

4. To provide a platform whereby parents and professionals can discuss and share knowledge as well as resources to treat autism.
(Treatment of autism is rather difficult and complex, as there is no ONE cure for it. Symptoms of autism can go away or minimise with treatment. Although some claim autism is incurable records of children who have come out of it and no longer show the symptoms of autism do exist! Whichever the case is, treatment of autism can guarantee an autistic child to be more independent and better off than who has not obtained it. The most important aspect of treatment is obtaining learning resources and guidance from other parents as well as professionals to deal with the children with autism.)

We shall welcome local contributors in order to enrich this weblog with information and resouces useful for the Maldivian society. If you are interested to become a contributor please do not hesitate to write to us stating why you want to be become one. Our email is autismmaldives@yahoo.com

101 Ways to Praise your Child

When a child does something good that action must be praised. Praising is a way of encouraging good behaviours to repeat. This helps to reinforce good behaviour in the child. This is the starting point of behavior modification. Children with special needs require behaviour modification to correct their behavioural problems such as poor eye contact, bad hand writing, poor attention, undesired behaviors, etc. However, behaviour modification is not specific to children with special needs, it can be used on anybody to get a desired behaviour.

Some parents unfortunately do not know what to say when his or her child does something good. I've included below some words, hoping these will be of help to those parents.

Wow * Way To Go * Super * You're Special * Outstanding * Excellent * Great * Good * Neat * Well Done * Remarkable * I Knew You Could Do It * I'm Proud Of You * Fantastic * Super Star * Nice Work * Looking Good * You're On Top Of It * Beautiful * Now You're Flying * You're Catching On * Now You've Got It * You're Incredible * Bravo * You're Fantastic * Hurray For You * You're On Target * You're On Your Way * How Nice * How Smart * Good Job * That's Incredible * Hot Dog * Dynamic * You're Beautiful * You're Unique * Nothing Can Stop You Now * Good For You * I like You * You're A Winner * Remarkable Job * Beautiful Work * Spectacular * You're Spectacular * You're A Darling * You're Precious * Great Discovery * You've Discovered The Secret * You Figured It Out * Fantastic Job * Hip, Hip, Hurray * Bingo * Magnificent * Marvelous * Terrific * You're Important * Phenomenal * You're Sensational * Super Work * Creative Job * Super Job * Fantastic Job * Exceptional Performance * You're A Real Trooper * You Are Responsible * You Are Exciting * You Learned It Right * What An Imagination * What A Good Listener * You Are Fun * You're Growing Up * You Tried Hard * You Care * Beautiful Sharing * Outstanding Performance * You're A Good Friend * I Trust You * You're Important * You Mean Alot To Me * You Make Me Happy * You Belong * You've Got A Friend * You Make Me Laugh * You Brighten My Day * I Respect You * You Mean The World To Me * That's Correct * You're A Joy * You're A Treasure * You're Wonderful * You're Perfect * Awesome * A Plus Job * You're The Best * A Big Hug * A Big Kiss * I Love You!

Bear in your mind that when you use these words with children with special needs you must use them jointly with non-verbal cues. That is, make yourself sound excited and exaggerate the action with a tickle, kiss, pat or something. Then only the desired outcome can be achieved.

What is RDI? Another therapy for autism?

Applied Behaviour Analysis (ABA) is a proven method to improve development progress in children with autism. It is more therapist-focussed, systematic and well-structured with lots of data gathering. Although it is believed to be effective and well recognised by stake holders of autism, it has been criticised for 'making a robot out of a child'. As a result another therapy method called Floortime came to being. Unlike ABA, Floortime is more child-centred. While the child takes the lead the therapist follows and engages with the child through fun and excitement.

Now we have Relationship Development Intervention (RDI). It is more focussed on improving interaction with the child through joint activities. If you wish to know more about this approach log onto http://www.rdiconnect.com/

Here are some videos http://www.rdiconnect.com/video/default.asp

On the left I've also included a link to a good website. There you can see how RDI is implemented by the parents as a lifestyle to encourage the child to interaction and respond more to them.

Please note that I do not imply that RDI is better than ABA or Floortime approach. For a good result I advise parents to use a combination of them while keeping in mind each child is different and a method which had worked on another child might not work for your child.

Little bit about Autism

What is Autism?

Children and adults who have an autism spectrum disorder look the same as other people, and due to the invisible nature of their disability it can be much harder to create awareness and understanding.

Autism and Asperger syndrome still remain relatively unknown disabilities among the general population. Yet it is estimated that autism spectrum disorders are approximately four times as common as cerebral palsy and 17 times as common as Down's syndrome.

What is an Autism Spectrum Disorder?

An Autism Spectrum Disorders is a life-long developmental disability affecting social and communication skills. People with the disability can also have accompanying learning disabilities; but, whatever their general level of intelligence, everyone with the condition shares a difficulty in making sense of the world.

Because of the differing degrees of severity and variety of manifestations, the term Autism Spectrum Disorder is often used to describe the whole range.

This term includes Asperger syndrome, which is a form of autism at the higher functioning end of the autism spectrum. People with Asperger syndrome are of average (or higher) intelligence and generally have fewer problems with language, often speaking fluently, though their words can sometimes sound formal and ideas which are abstract, metaphorical or idiomatic may cause confusion and be taken literally. Unlike individuals with 'classic' autism, who often appear withdrawn and uninterested in the world around them, many people with Asperger syndrome try hard to be sociable and do not dislike human contact. However, they still find it hard to understand non-verbal signals, including facial expressions.

What causes the condition?

The exact cause or causes is/are still unknown but research shows that genetic factors are important. In many cases Autism Spectrum Disorder may also be associated with various conditions affecting the brain such as; maternal rubella, tuberous sclerosis and encephalitis.

Onset is almost always from birth or before age three, although people with the condition may go through life without being diagnosed - and without receiving help that could help them live more fulfilled lives.

Who is affected?

"Classic" autism affects four times as many boys as girls; Asperger syndrome affects nine times as many boys as girls. It is found among all races, nationalities, and social classes
Can people with autism spectrum disorders be helped?

An autism spectrum disorder is a life-long disability, but there are ways of helping, especially if a child is diagnosed early and receives appropriate intervention early in life.

Special education programmes and structured support can really make a difference to a child's life, helping to maximise skills and achieve full potential in adulthood. An early diagnosis of an autism spectrum disorder is essential in order to ensure appropriate support is given

How common are Autism Spectrum Disorders?

1 person in 100 has an Autism Spectrum Disorder, this includes people who have Asperger syndrome.

The figure include people at the higher functioning end of the spectrum who may not need specialist services and support, but who will still benefit from early recognition and sympathetic understanding of their special needs and unusual pattern of skills.

Recognising the disorder

Features of the disorder can vary widely from one person to another; there is no single feature that defines either autism or Asperger syndrome.

For example, a child with an autism spectrum disorder may make eye contact, speak with perfect grammar or put an arm around another child who is crying. Occasional behaviour such as this doesn't exclude an autism spectrum disorder; it's the overall pattern that's relevant, not the intermittent flashes of "normality".

The degree to which people with an autism spectrum disorder are affected varies, but all those affected have impairments in social interaction, social communication and imagination. This is known as the "triad of impairments".

Social interaction

People with autism spectrum disorders have difficulties with social relationships. They may, for example, appear aloof and indifferent to other people or passively accept social contact, even showing some signs of pleasure in this, but rarely making spontaneous approaches
Social communication

People with an autism spectrum disorder also have difficulties with verbal and non-verbal communication, for example not fully understanding the meaning of gestures, facial expressions or tones of voice.

Imagination

There are difficulties in the development of play and imagination, for example children do not develop creative "let's pretend" play in the way other children do. They have a limited range of imaginative activities, possibly copied and pursued rigidly and repetitively.

Children and adults tend to focus on minor or trivial things around them - an earring rather than the person wearing it, the wheel of a toy rather than the car itself. They also tend to miss the point of pursuits involving words, such as social conversation, literature, especially fiction, and subtle verbal humour

Repetitive behaviours

In addition to this triad, repetitive behaviour patterns are a notable feature, as is a resistance to changes in routine. People with autism spectrum disorders often become obsessed with particular objects or behaviours, focussing on them to the exclusion of everything else

Sensory Issues

People with an Autism Spectrum Disorder may have "sensory issues" or a difference in sensory integration, where they can be either hyposensitive or hypersensitive to outside stimuli.

This means that a person can be very sensitive to particular sounds, light, smells and touch etc. Particular sensations may be very absorbing and pleasurable, others may be perceived as unbearably intense, stressful and even painful. The anticipation of such an experience can lead to extreme anxiety or panic. There may also be a lack of sensitivity and therefore response to pain. These type of experiences can often be very bewildering to parents, teachers and other ‘neurotypicals’.

Special abilities

Some people with autism spectrum disorders, who may be severely disabled in most ways, will sometimes display talent for say, music, mathematics or technology. Some have a remarkable memory for dates and things that particularly interest them
What do I do if I suspect an autism spectrum disorder?

If you suspect an autism spectrum disorder is present, have the person referred (or suggest they ask) for a specialist diagnosis and assessment as early as possible through a doctor. If possible get a referral to clinical psychologist.

Has anyone heard of Chitra Lane School in Colombo?

While searching for autism therapy centres or schools in Sri Lanka I came across Chitra Lane School in Colombo.

On the website of Autism Sri Lanka I read:

"The Chitra Lane School in Colombo is one of only a handful of schools in Sri Lanka who have any sort of expertise on Autism and Asperger's Syndrome - they even employ speech therapists. We urge you to support this school, please access their website and why not fund the education of an autistic child in Sri Lanka - particularly children who come from underprivileged families who do not have access to funds to educate their children. This school is a real example when it comes to Special Needs Education."

The website of the school is given as http://www.chitralane.org which is dysfunctional.

If anyone has any info on this school, could you please pass them on to us so that we can provide it for our visitors?

Sri Lanka being a good neighbour of Maldives, we call upon Sri Lankan visitors to web blog to provide information about diagnosis facilities and therapy programs in Sri Lanka.