Social Network Shutdown

Autism Awareness or Another Social Fad?

On November first we are asked to shut down our social networks, to refrain from updating our Facebook statuses or tweet for 24 hours to show support for autism. As professionals, parents, teachers, and individuals with ASD, we really need to ask ourselves…

“Is this really going to bring the autism community together, make us stronger, bring on more support, awareness and acceptance OR is this just another social fad?”

As founder of Garden | Autism Services of Colorado and an early childhood mental health specialist for children with autism, I feel compelled to speak out against this worldwide social network shut down campaign. Garden’s mission is to support, empower, and advocate on behalf of all families affected by autism as well as the professionals that support those families.

Many social medians such as Twitter and Facebook bring individuals with autism and Asperger’s together in ways that they would not otherwise be able to connect and share their combined experiences. To take that away, even for a day, is a disgrace. I propose a campaign, every hour for 24 hours we tweet and status update about autism. For 24 hours on November first, autism awareness will be raised, not ignored. Together let’s fight the good fight. Speak up for those who are unable to speak for themselves. Do not fall for yet another social fad. Stand up for what’s right, not what’s hot.

For more information on the Worldwide Social Network Shutdown visit www.CommunicationShutdown.org

As always, your feedback and opinions are welcome. Together we can make a difference in the lives of those we love most.

Until next time, BLOSSOM!

Lauren Thome, M.A.

Prevent-Teach-Reinforce: A Model for School-Aged Interventions

"The PTR Assessment and Intervention process is based on a scientific understanding of how problem behavior is related to and influenced by events and circumstances in the environment."

-PTR Team Manual, USF & UCD (2006)

Overview
Developed by the University of South Florida and the University of Colorado in 2006, this model is designed to guide school-based teams through the Prevent-Teach-Reinforce (PTR) process for supporting students, K through 8th grade, with problem behaviors. With a focus on creating positive behavior supports, this model is heavily aligned on the principals and procedures of applied behavior analysis (ABA). By using functional behavior assessment procedures, reinforcement of desired behaviors, shaping of new behaviors, fading of prompts and reinforcement, and contingency management approaches, this model is applicable to students at all levels of functioning whose behavior problems have presented a significant barrier to instruction for the student and his or her classmates. The PTR consists of five steps including team building, goal setting, assessments, intervention, and evaluation. We will being with the first step--Team Building.

Step One: Team Building
A school-based team should be comprised of individuals who will meet regularly, that will be responsible for developing, implementing, and evaluating the intervention. These teams should include anyone who knows the student or works with them on a consistent basis, including members of his or her family. It is critical for team members to share responsibilities and are held accountable for the plan's implementation allowing for consistency and generalization.

Step Two: Goal Setting
Goal setting is the second step in the PTR intervention model for school-aged classroom behavior management. Once a team is established, the next step is to agree upon the team's vision regarding the broad, future outcomes they want to see for the student. Once a vision is created, short-term goals can be developed. These goals can be similar to the annual goals established in the student's Individual Education Plan. It is important to keep in mind that goals should be able to transfer to multiple environments, with multiple people, and lead to a higher quality of life. Four areas that should be examined include the educational or community setting in which the student will be included, the social relationships of that student, curriculum or academic success, and his or her behavioral outcomes. Once short term goals are determined, baseline data should be taken, using a behavior rating scale, to make sure each goal is observable, measurable and significant impact on the student's life.

Step Three: PTR Assessment
PTR Assessment--The third step in this process takes a closer look at the specific information regarding the student's problem behavior(s). Two major principals underlying this step is first understanding that problem behavior often has a functional and communicative purpose and second, understanding that behavior can be influenced by the events and context in which it occurs that, in turn, trigger the behavior. In order to assess a student's behavior your team must take an individualized look at the prevent component, teach component, and reinforce component as outlined below:

• Prevent Component:
• Determine the times of the school day or specific circumstances when problem behavior is most likely and or least likely to occur.
• Determine if there are specific activities when problem behavior is very likely to occur.
• Determine the specific activities that cooperative and prosocial behavior is most likely to occur.
• Determine if there are specific classmates, adults whose proximity or physical environments are associated with a high likelihood of problem behavior.
• Determine if there are circumstances unrelated to the school setting that occur on some days and not on others that make problem behavior more likely.
• Teach Component:
• Determine if the problem behavior gains attention from others.
• Determine if the problem behavior is often exhibited to gain access to preferred items or to delay a non-preferred task, person or transition.
• Determine what social, problem solving, and communication skills could the student learn in order to reduce the likelihood of the problem behavior occurring in the future. 
• Reinforce Component:
• Determine what consequences usually follow the student's problem behavior.
• Determine if the student enjoys praise and what school-related activities are most enjoyable to the student.

Step Four: Intervention Plan

The next step is to develop an intervention plan. Your team's plan should include at least one Prevent Component, Teach Component, and Reinforce Component in the student's plan. 

• Prevent Teach Interventions
• Provide choices
• Transition supports
• Environmental supports
• Curricular modifications
• Frequent adult verbal positive attention
• Classroom management
• Setting event modifications
• Opportunity for pro-social behavior and peer support
• Peer modeling and reinforcement 

Example Prevent Intervention: The student is most likely to engage in problem behavior during a writing assignment which requires capital and lowercase letters to touch the appropriate lines on the paper. The team might choose to use a curricular modification that includes coordinating the letters of the words with different colored lines to assist the student in determining what letter should touch which line. This prevent component has eliminated the trigger for the problem behavior. 

• Teach Intervention
• Replacement behaviors functional or equivalent
• Replacement behaviors desired or prosocial
• Specific academic skills
• Problem solving strategies
• General coping skills
• Specific social skills
• Teacher pleasing behaviors
• Learning strategies
• Self-management
• Delayed gratification
• Independent responding
• Increased engagement time

Example Teach Intervention: Prior to intervention, the student calls out repeatedly to get the teacher's attention. The functional replacement behavior would be to teach the student to raise his or her hand to get assistance from the teacher.

• Reinforce Intervention
• Reinforce replacement behavior
• Reinforce replacement behavior non-functional or desired, pro-social
• Increase non-contingent reinforcement
• Discontinue reinforcement of problem behavior
• Group contingencies
• Increase ratio of positive to negative responses
• Home-school reinforcement system
• Crisis intervention plan

Example Reinforce Intervention: Prior to intervention, the student kicks the desk each time he or she is asked to complete an independent reading assignment. As a result, the student is sent the the principal's office thus escaping the task and getting attention. After intervention, the student is no longer sent out of the classroom when presenting problem behaviors. However, they will be allowed out of the classroom when he or she completes at least ten minutes of independent reading.

Coaching and implementation of the PTR Intervention Plan should take place after your team has selected the specific PTR interventions. There should be a training session that takes place in the classroom without the student present, when the student is present, and a final coaching session in the classroom with all students present two weeks after the final observation.

Final Step: Evaluation
Once your team has selected interventions to decrease problem behavior and increase prosocial behavior, it is important to continue to collect outcome data that will let your team know if the intervention is effective. Your team should observe the classroom interventions, continue to train staff and follow-up with all members to discuss the outcomes and make adjustments to the intervention plan as needed.

The contents of this manual were developed by the University of South Florida and the University of Colorado at Denver under the Department of Education in 2006. 

Until next time, BLOSSOM!

Lauren Thome, M.A.

Autism & Sleep Disorders

It is not uncommon for families affected by autism to be on the "sleep less, work more schedule," for many it has just become a way of life. However, there are ways to improve your sleep schedule resulting in improved alertness, performance, memory, concentration, better health and mood for both you and your child with autism. This article is a review of the techniques discussed, researched, and utilized by Dr. Terry Katz (2010), an autism sleep disorder specialist.

It is found that up to 83% of children with autism have sleep disturbances-- That is an epidemic! Katz explains that "sleep is needed to remember what we learned, organize our thoughts, engage in tasks of executive functioning, react quickly, work accurately and efficiently, think abstractly, and to be creative," (2010). These apply to all individuals with and without disabilities. Newborns need up to 20 hours of sleep per day, toddlers need 13 total hours, school-aged children  need 10 hours, and adolescents should get at least 9 hours of sleep per night to feel rested and perform at their best the following day.

There are ways in which our environment cues us when it is and is not appropriate for sleep or when to be tired, these cues are called zeitgebers and literally mean "time givers." Zeitgebers include light, time cues, and social demands. Zeitgebers almost get tossed out the window for children with autism because of sensory integration disturbances, inability to tell time, and inability to pick up on social cues; thus resulting in the high percentages of sleep troubles for these families. Beyond zeitgebers, children with autism also experience sleep rhythm and neurotransmitter abnormalities as well as anxiety.

A study by Malow in 2006 found that changes in sleep can result in decreased social withdrawal, decreased anxiety, and decreased emotional reactivity. So, the question is, "how do we improve our sleep?" The first place to start is in behavioral and environmental strategies including, but not limited to the following:

• Rewards for sleeping through the night
• Consistent wake time (yes, even on the weekends)
• Elimination of naps
• Increased physical activity during the day
• Increase in natural light during the day
• Consistent bedtime (even on the weekends)
• Consistent bedtime routine
• Participation in calming activities within 2 hours of bedtime
• Reduction of light within 2 hours of bedtime
• Use of a visual schedule

Make sure you are aware of your child's bedroom environment. Pay attention to the temperature, amount of light and noise in the room. A bedroom should be used for sleep only. If a child's bedroom is also their play room, then they will associate that space with what is most motivating and rewarding-- Play. 

Also, consistency is key in both falling asleep and staying asleep. What a child falls asleep to needs to be consistent throughout the night in order for them to stay asleep. Everybody falls asleep and wakes up every 90 minutes throughout the night, naturally. If your environment is not consistent throughout the night, then it could be difficult to fall back asleep. For example, if a child only falls asleep in your arms, their body will wake them up throughout the night and that child will crawl back into your arms in the middle of the night to feel that same comfort they felt at the beginning of the night. 

A great behavioral intervention I have found to be very helpful is "The Bedtime Pass," (Katz, 2010). Children can use a bedtime pass to leave their bedroom during their bedtime, whether it is to use the bathroom or crawl into bed with mommy and daddy. Parents are in control of how many passes they allow their child and are able to reduce the number of bedtime passes as their sleep gets progressively better and more consistent. If the child did not use all their bedtime passes and stayed in their bed throughout the night, they can turn in their pass in the morning for a prize. This program if very rewarding and effective for children young and old, with and without disabilities, who are having trouble falling asleep and staying asleep throughout the night. 

Another intervention that should be discussed with your doctor is the addition of melatonin or serotonin supplements. Melatonin and serotonin are naturally produced in the body, but it has been said that children with autism have disturbances in the production of these chemicals. Melatonin tells the body when it is tired and serotonin is necessary for the body to produce melatonin. So, if you try a melatonin supplement and you don't see any results, speak with your doctor about serotonin supplements. 

Use these strategies intending on trial and error. Make sure you keep a sleep diary so that you are able to track what works and what doesn't work. Gradually you will see an increase in improved sleep and thus an increase in your overall quality of life. 

References:

Katz, T. (2010). Behavioral Treatments for Sleep Problems in Individuals with DS-ASD. Denver, Colorado: Annual DS-Autism Connection Conference.

Until next time, BLOSSOM!

Lauren Thome, M.A.

GFCF & Autism: Featuring Erin McCahill, RD

Why try the Casein/Gluten free diet?

Autism is a complex disease because of its affect on the digestive, immune, endocrine and nervous systems.  This illness arises from a combination of genetic factors and environmental exposures.

One theory of the cause of autism is its association with the gut. Leaky gut syndrome has been shown in some studies to occur in children with ASD. This is a result of damage to the intestinal lining, which leads to a poor absorption of nutrients. A decrease in stomach acid production, poor stimulation of small intestine secretions and inflammation occurs. Malabsorption of nutrients can cause an imbalance in neurological function and behavior, liver toxification, immunity, and hormones produced from the endocrine glands.  The brain is exposed to morphine-like peptides that have been linked to delayed and altered maturation. Foods that contain gluten and/or casein have these morphine-like substances, which are left over in the body after digestion.

Please note that this is only a theory and has not been proven to be affective in many empirical studies. However, there are a small group of studies that have proven that this diet can control some of the autistic behaviors. A GCF diet will not harm your child as long as you follow a well-balanced diet.  If you choose to try this diet, please know that its not an overnight fix and that it takes the body several weeks to repair and adjust if your child does suffer from gastrointestinal damage.

What is Gluten?

Gluten is made up of two proteins called gliadin and glutenin. It is typically found in wheat, rye, and barley grains. It can also be found in oats if cross contamination occurs in the milling process.

What are typically names on food labels that contain gluten?

Starch, Modified Food Starch, Hydrolyzed Vegetable Protein, Hydrolyzed Plant Protein, Texturized Vegetable Protein, Binders, Fillers, Malt, or Malto-dextrose

Examples of foods that may contain gluten:

·      Cereals

·      Breads

·      Imitation meats that resemble chicken, duck, fish, pork, or beef

·      Ice cream

·      Ketchup

·      Most beers

What grains DO NOT contain gluten?

·      Wild rice

·      Corn

·      Buckwheat

·      Millet

·      Amaranth

·      Quinoa

·      Soybeans

·      Oats (if no cross contaminated)

What is Casein?

It is one of the two proteins that are found in dairy, the other is whey protein.  It can be used as a binding agent and therefore is found in various foods.

What are typical names on food labels that contain casein?

Sodium Caseinate, Calcium Caseinate, Milk Protein, or Milk Solids

**Do not assume that lactose free foods are casein free! Lactose is the sugar in dairy foods.

Examples of foods that may contain casein:

·      Milk

·      Cheese

·      Cottage Cheese

·      Ice-Cream

·      Butter

·      Cream

·      Yogurt

·      Energy Bars

·      Lactose free foods

·      Soy cheese

·      Processed foods

·      Lunch meat

·      Sausages

·      Hot dogs

·      Canned tuna

·      Chicken broth or bouillon

·      ‘Fresh’ Poultry – all natural foods can have up to 5% other additives

·      Wine

·      Protein Shakes

List of Food Brands that are available Gluten and Casein Free:

·      Quinoa

·      Tinkyada Pasta Joy (brown rice)

·      De Boles Pasta  (rice quinoa and amaranth or corn)

·      Annie’s Homegrown Pasta

·      Bob’s Red Mill  (rolled oats, steel cut oats, all purpose baking flour, hot cereal)

·      Enger Egg Replacer and Enger Breadcrumbs

·      Namaste Foods (brownie mix, waffle and pancake mix)

·      Gluten Breakfast Bars (apple, cranberry, blueberry)

·      Bakery on Main Granola (rainforest, triple-berry, cinnamon raison, cranberry orange cashew)

·      Perkys Crunchy Rice Cereal and Crunchy Flax Cereal

·      SunFlour Baking Company

·      San-J Rice Crackers

·      NOoodle (made up of soluble fiber from Japanese yam)

Milk Alternatives:

·      Soy milk

·      Coconut milk (SoDelicious)

·      Hemp milk

·      Almond Breeze and Hazelnut milk

What are TWO supplements that I would suggest?

Probiotics are good bacteria that help balance the bacterial flora in the gastrointestinal tract. It has been shown to control the growth of the bad bacteria and toxins that may be produced from a damaged gastrointestinal tract. Many food items that contain the beneficial bacteria come from foods that contain casein.

A company called New Chapter has a non-dairy supplement called Probiotic All-Flora. Their supplements contain compounds derived from WHOLE FOODS that undergo a fermentation process. This enhances nutritive bioavailability because your body recognizes it as whole food, rather then chemical isolates that other supplement companies use. It is certified organic which means that the whole food ingredients are grown without the use added chemical pesticides, herbicide, residues, or genetic engineering.

Omega 3 oils are essential fatty acids that are vital to incorporate into you child’s diet. The two omega-3 fatty acids that have shown to provide the most benefit are EPA and DHA. They are both found in fish and some shellfish, however the most is found in salmon. The brain is made up of 60-70% fat, mostly of DHA. Omega 3 oils have shown numerous benefits in mental health.  New Chapter provides a supplement called Wholemega Fish oil. Many fish oil supplements undergo a high heat purification process, which can destroy some of the beneficial compounds in fish. New Chapter uses only wild caught Alaskan salmon that is pressed immediately (no heat is used to extract) to preserve the purity.

Please visit their website to find out more information:

http://www.newchapter.com/

This article was brought you to by ERIN McCAHILL, RD. If you would like to be considered as a featured guest writer for Garden | Autism Services Colorado please email us at Info@GardenColorado.org!