"First do no harm."
Early intervention is an important component of treatment for our little children but we must know what we are doing before we start, in order to ensure that we are not doing more harm than good. The direct result of many of the early intervention programs I have come in contact with over the years is the development of a number of psychological problems including post traumatic stress disorder (PTSD), low self esteem, depression, and opposition defiant disorder. These are all direct results of the heightened level of anxiety that the treatment programs force the child with autism to endure during treatment sessions. Any child who is kicking, screaming, crying, trying to escape, in shutdown or not interacting with the therapist in a positive manner is a child experiencing trauma due to the lack of understanding of autism in the particular program being used.
There are two major factors that we must pay attention to in the development of effective early intervention programs. The first, of course, is a clear understanding of how autism is affecting the individual child the programs is being developed for. We must clearly understand the relationship that sensory input, level of anxiety, bio medical concerns and boredom have with the symptoms of autism we are dealing with. Since this is "early" intervention, we must also clearly understand and respect how the brain is constructed through sensory input after birth. Anything we do a child at this point in time is going to affect the actual construction of their brain for the rest of their lives. This is why "first do no harm" must be the basis of any early intervention program and why understanding the impact of sensory input is so crucial to our children.
Early intervention programs are necessary because the child on the spectrum has difficulty initiating their own learning or communicating clearly to access what they need to know from us. The typical questions of typical 3-year-olds do not happen because the child has a communication impairment. This doesn't mean the child doesn't have the questions or need the answers. It just means that they have to find other ways to answer them themselves, because they cannot ask them of us. So a major component of any early intervention program is to make the effort to teach these children how the world works in spite of their impairment in communication.
Early intervention programs are also important because they allow our children to keep their very busy brains active and involved in our world. The direct result of heightened anxiety due to stimulation from the environment, from within and from boredom leads to the need to protect oneself often through the use of shutdown. If we want we want them to learn and interact in our world we must make certain that their anxiety level is kept as low as possible so that shutdown is not needed. In other words:
A safe environment plus a safe relationship
leads to feelings of acceptance and trust
which in turn lead to the freedom to participate and to learn
Like educational programs for those with autism, any early intervention program developed for children on the autism spectrum should be based on this simple rule: Decrease the amount of sensory stimulation while increasing the mental stimulation.
Suggested Curriculum for 3 Year Old with Autism
Gail Gillingham Wylie
Autism Consulting Service
In home activities. Prefer 5 mornings a week, from nine to one. Focus: learning how our world works by answering the "why" questions that are prevalent in the lives of this age of children.
Afternoons: Mondays Wednesdays and Fridays: (3 hours a day) small group interaction in a very structured, small group playschool or day home. Focus: learning Social Skills based on the reality we learn best from our peers.
Afternoons: Tuesday and Thursdays: (3 hours a day) In the community. Focus: leaning how to interact in a variety of community settings.
Suggested In-Home Activity Schedule
Note: this is only a suggested schedule, not one written in stone. The schedule does not need to be followed as directly as written. Can be varied in any way which suits you best. Each 5-20 minute segment is approximate in time and may be made up of a number of different activities, moving from one to another as each is complete, or the child appears to be bored with it or refuses to continue to participate. In the beginning it is likely that you cannot go for 20 minutes at a time in some of these areas. If not, do ten minutes, move to another area, and then do the other ten minutes later on. However, we are also working on developing the child’s attention span so the longer in one area, the better. During breaks the child can be allowed to do whatever he/she wants while the therapist gets things ready for next segment, or therapist can do something with him/her, such a deep pressure or vestibular activities (rolling him up in something, jumping on the bed, rocking, and so on) ]
9 AM to 12 noon
5-20 minutes: structured play using current or new (borrowed) toys. Child led. Therapist parallel plays alongside the child, following his lead and initiating new ideas.
Suggestions: playing with the garage and the cars
playing in the cardboard house
a train set
pretend play with stuffed animals or dolls
play farm sets, castles, house, airports
buses with people who ride in them
building a fort with cushions
5-20 minutes attending skills:
- read a book (present at least one new book each day, and then use favorites to fill in the time)
- find things in the pictures (point to, show me, instructions) objects, animals, people, colours, shapes, numbers, concepts (beside, on top of) and so on
- make the sounds of the animals, etc.
- make sure a majority of the books are real stories with a plot and a climax. Most children’s books aren’t.
5 minute break
5-20 minutes of imitation ( may use songs on some days, but also try it without)
- gross motors movements (tap table, clap hands, wave, place arms up, stomp feet, tap legs, shake head, nod head, turn around. cover face with hands, tap shoulders, jump, circle arms, tap stomach, march, put arms out knock on something, put hands on wait, rub hands together, tap head, rub stomach,)
- actions with different objects (place block in bucket, ring bell, push toy car, wave flag, hit drum, put on hat, scribble, wipe mouth, bang toy hammer, shake maraca, feed doll, hold phone to ear and talk, drink from cup, blow horn, brush hair, make actions with a doll or stuffed animal, roll play dough, place coin in bank, kiss doll, stamp paper)
- fine motor movements (clasp hands together, open and close hands, tap index finger, tap thumbs, wiggle fingers, rub hands together, tap index finger to thumb, point to body parts, point index finger to palm, extend index finger, place thumbs up, make peace sign)
- oral motor movements (open mouth, stick out tongue, put lips together, tap teeth together, blow, smile, pucker, kiss, place tongue to top teeth, place top teeth over lower lip)
15 minute break: snack time
5-20 minutes of computer skills
5 minute break
5-20 minutes of visual skills (puzzles)
- need some variety here, new puzzles as well as the ones he already excels at.
5 minute break
5-20 minutes of writing skills
- drawing, colouring, painting,
- use bingo markers, felt markers, finger painting, stamps, whatever, to get him/her used to making a mark on things.
- Beginning to use pencil to write name
5 minute break
5-20 minutes of music skills
- playing the piano
- listening to taped music and singing along, or playing some kind of instrument along to the music (drum, rattle, etc.)
5-20 minutes of science skills (exploring the environment)
- water play
- hot and cold
- sand play
- movement (pushing him on his car, or making various objects move: fast, slow, etc.)
- magnifying glass
- changing colours
5 minutes break
5-20 minutes of listening skills: (be very aware of auditory sensitivity!
- listen sounds in the environment
- play games with sounds.....find the bell, the buzzer, the candy unwrapping.
- identify sounds (i.e.: Match animal noises with pictures of the animal)
- following instructions (put the ball in the box, find the red car, et.)
5 minute break
5-20 minutes of physical skills:
- walking, running
- riding trikes/bikes, etc.
- crawling through tunnels
Noon: lunch preparation (the child can help) and time to eat
Throughout all of the above work on:
1. Receptive Language Skills
- following one step instructions
- identifies body parts
- identifies objects
- identifies pictures
- identifies familiar people
- follows verb instructions
- identifies objects in the environment
- points to pictures in books
- identifies objects by function
- identifies possession
- identifies environmental sounds
2. Expressive Language skills:
- points to desired objects in response to what do you want?
- points to desired objects spontaneously
- imitates sounds and words
- labels objects
- labels pictures
- requests desired items or action with sign or gesture
- verbally requests desired items or action
- states or gestures yes or no for preferred and non preferred items
- labels familiar people
- makes a choice
- reciprocates greetings
- answers social questions
- labels verbs in pictures, others and self
- labels objects by function
- labels possession
3. Pre-academic skills:
- matches (identical objects, identical pictures, objects to pictures, pictures to objects, colours, shapes, letters, numbers, non identical objects, objects by association)
- completes simple activities independently
- identifies colours
- identifies shapes
- identifies letters
- identifies numbers
- counts to 10
- counts objects
Community Activities: a few suggestions (Edmonton based program, you can modify this for wherever)
- indoor playgrounds
- outdoor playgrounds
- swimming pools
- outdoor wading pools and water parks
- visit the sea lions, or fish tanks, or underwater caverns, or dinosaurs, or flamingos, or rocks or whatever (there is so much to do) at West Edmonton Mall
- miniature golf
- visit a pet store
- visit Dejabii’s ( a grocery store that offers samples of all their fruits and vegetables) and test the various samples
- feeding the geese at Hermitage park
- walk around the lake at Hawrelyk or Rundle
- a ride on the LRT
- a visit to a Farmers Market
- tobogganing, sledding
- building a snowman, snow angels, snow balls
- petting zoos
- visit a toy store
- children’s musical performances
- explore a trail in the various ravines in the city
- the festival of the week
- flying kites
- science centre
- a visit to a greenhouse
- a visit to various kinds of farms
- horseback riding
Watch the Ten Best each Friday in the Entertainment Section of the Edmonton Journal.....often has a lot of interesting things going on from reptile shows to monster truck rallies ( which, of course, is not a great choice due to the sensory input). But a lot of them are.
Note: this is the general plan of the program that we have used with one child since he was 2½ years old. At this point he is dressing himself on his own, toilet trained most of the time (he still slips up during times of stress), knows all his colours, shapes, letters, numbers (counts on his own to 30+), animals, parts of the body, plays games on the computer using the mouse on his own and is beginning to type, plays the piano, sets puzzles and so on......There is so much that it is difficult to remember it all. He has difficulty cutting with scissors, only works with a pencil for short periods of time, and although he does speak, his output is not at a peer level at this time.........he will be 4 in September.
In the beginning a lot of his interactions with world were hand over hand....for example holding his hand to touch the trees to show the difference between rough and smooth etc. At this point he is interacting in this way on his own.
His aides had a bit of difficulty coming up with ideas in the beginning so we instituted a focus of study....for example : the month of
September we focused on the season of fall, in October, on dinosaurs and so on.....this made it easier to develop different projects to keep him involved.