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What I am listing here for you is what I consider “The Big Ten” of autism. It is a list that I compiled to help people include and support children with autism spectrum disorders. If you do not understand anything that I have written, be sure to ask for help. Not every item will apply to every child, so choose what seems the most relevant for your situation and the child with autism you are supporting.
The Big Ten
1. Children on the autism spectrum have “differences in reciprocal social interaction.”
This can include:
- Difficulty making friends and sustaining friendships
- Awkward social attempts
- A naïve approach toward others
- One-sided social approaches
- A tendency to play or work alone
- Apparent lack of interest in others
- Problems joining in with groups who have already formed
- Problems working within groups
- Social “youngness” for the child’s age
- Authoritative speech or what sounds like “bossy” speech
- More social success with adults than with peers
- Timing issues: missing cues to switch topics at the lead of a communicative partner
- Social vulnerability: can be taken advantage of by others
- Problems with conversational skills such as being less able to “repair” a conversation or clarify upon request
- Less ability to predict the behavior of others by reading social cues like facial expression, body language, and tone of voice
- Giving attention to others who do not want it
- Appearing to want to be alone much of the time
- Under-responsive to the overtures of other children
- Socially “predictable” with a limited repertoire of social skills
- Appearing rude or uncaring about others
- Appearing self-absorbed or aloof
- Viewed by other children as odd, weird, or unpleasant
Understand: Social ineptness is not intentional. Children with ASD care about others, but their disability prevents them from automatically being able to show caring in a typical way. They very much want to have friends and be included.
Teach: Teach simple social skills like handing out or collecting, giving compliments to others, and how to join in a game or activity. Use visual strategies to teach social skills.
Support: Speak on behalf of the child with ASD. Do not punish social mistakes. Help explain the child’s intentions.
Protect: Provide ongoing supervision, especially in groups of moving children of any age. Identify needed safety skills and tell members of the team.
Inform: Talk to staff and peers about the social needs and desires of the child with ASD while abiding by confidentiality rules and laws.
Model: Do not overreact to social mistakes or take social mistakes personally. Show that you like this child even though he sometimes makes social mistakes or misses cues.
2. Children on the autism spectrum will have restricted, repetitive interests, activities, and behavior.
Effects can include:
- Difficulty with maintaining a topic at the suggestion or lead of a conversational partner
- Tendency to talk and think about only a few topics to the exclusion of other topics
- Being a fountain of knowledge on one or two topics far beyond what one would expect
- Becoming very absorbed in the liked topic, more so than is typical for a child of that age
- Apparent inattentiveness to less preferred topics
- Repetitive motor movements
- Repetitive object use schemes
- Seeking the same few people, places, toys, actions, activities, books, and games rather than seeking new experiences and materials
Understand: Restricted, repetitive interests are not optional or chosen. The interests are “hard wired,” but they will change over time. Consider restricted interests as “open pathways” into the child’s brain. Remember that restricted, repetitive interests can lead to lifelong occupations. If restricted interests are dangerous or disturbing, convene the team to talk about your concern.
Teach: Expand restricted interests rather than try to eliminate them. Direct the child to areas of their interest that are more age appropriate if needed.
Support: Find others who share that interest. Allow the child to use the interest in some social conversations to show competence.
Protect: Protect the child from ridicule or social isolation caused by his interests.
Team: Inform team members about the restricted, repetitive interests and their effects on social interactions and learning. Identify what the child needs to learn to do to be more successful. Involve team members in teaching new skills.
Model: Try to find something to talk about in the area of interest. Praise the child for knowledge gained.
3. Children on the autism spectrum will have verbal and nonverbal communication issues and problems.
Effects can include:
- No speech
- Limited or no responses to what others say/do
- Communicating without identifying the communicative partner
- Echolalia: repeating what was said by another person immediately or after a period of time
- Repeatedly asking the same questions
- “Movie talk”: saying things from movies and television that have only tangential relationships to the conversation
- Conversational “word” matching in social conversations rather than “concept” matching
- Missing social signals and cues of others
- Not always using appropriate tone of voice
- Difficulty using relevant facial expression
- Less ability to predict the behavior of others
- Missing messages sent by others with nonverbal communication such as facial expression and tone of voice
- Literal mindedness: literal interpretation of what is said
- Difficulties with word retrieval, especially under stress
- Not knowing what is inferred or implied by another
Teach: Teach what to say and do, rather than focusing on what not to say or not to do.
Support: Identify areas of needed communication skills and be sure therapies and services address them. Prioritize any skills related to the safety of this child or others.
Protect: Provide ongoing supervision, especially in groups of moving children of any age. Identify environments where lack of communication skills could lead to being harmed, harming others, or being penalized or punished. Do not punish or embarrass the child for having poor communication skills.
Inform: Talk to the other children about the special communication issues of the child and how much the child wants to communicate well.
Model: Use repair strategies to help the child communicate effectively. Practice using feedback and checking for comprehension. Allow sufficient time for communication.
4. Children on the autism spectrum will likely have fine and gross motor issues.
Fine motor issues effects can include:
- Difficulty with the use of the hands and fingers for fine motor tasks
- Problems with handwriting, both printing and cursive
- Less ability to do self-care skills that have fine motor aspects
- Avoidance of fine motor tasks (learned response)
- Needing more time for tasks that involve fine motor use
Gross motor clumsiness and motor issues effects can include:
- Difficulty running, skipping, jumping, jumping rope
- Poor balance and control of limbs
- Problems with sports and physical education activities
- Lower muscle tone, especially in the upper body
- Avoidance of physical exercise and activities that require coordination and stamina (learned response)
- Problems with planning and carrying out motor tasks
Understand: Understand that motor issues are diagnostic. Sometimes they can be embarrassing. Do not use low skill area motor tasks as consequences for inappropriate behavior. Motor skills improve best when specific therapies and treatments are used to address them. Tell the team what you notice the child needs to learn to do.
Teach: Teach the most important fine and gross motor tasks that will be needed across the child’s lifetime. Prioritize. Teach the child when and how to ask for help.
Support: Find ways to help the child accomplish what is difficult for him or her more easily, with technology, or by having other children or adults help the child.
Protect: Provide ongoing supervision during physical activities and while using implements and tools.
Model: Provide assistance as needed without penalizing or embarrassing. Encourage the child with ASD to help others in areas of his strengths.
5. Children on the autism spectrum will have issues related to how they understand and react to information that comes in through their senses—sometimes called sensory integration issues.
Sensory integration is the ability of the brain to integrate and respond well to information that comes to it through our senses: touching, being touched, and smelling, tasting, hearing, and seeing. Many children on the autism spectrum have sensory systems that do not work in a typical way.
Effects can include:
- Over-responsiveness to sensory input
- Under-responsiveness to sensory input
- Difficulty tolerating sensory input that others do not find problematic
- Painful response to sensory input that others do not find painful
- Avoidance of some sensory input that others do not find problematic
- Seeking sensory input that others do not seem to need or seek
- Difficulty self-regulating and maintaining a consistent emotional response to events
- Sensory overload, which can result in “meltdowns” that can cause the child to “shut down” and stop taking in and successfully processing input
Understand: Sensory integration problems can underlie many behavioral issues such as talking or moving at the wrong time, “disregulating” or losing control, shouting, restlessness, unusual ways of using objects, unusual responses to heat and cold, more or less than the usual ability to handle pain, etc. Addressing these issues as sensory issues rather than “behavior problems” will be most effective. Sensory issues often respond very well to therapies and treatment based on a sensory integration assessment.
Teach: Help the child learn to use sensory language to identify and meet his sensory needs. Teach the child to identify and move away from sensory input that is aversive, uncomfortable, or unpleasant for him.
Support: If the child has sensory breaks or other activities prescribed by an occupational therapist (OT), be sure that these are carried out according to the OT’s plan.
Protect: Be aware of any sensory issues that could harm the child or others. Do not insist that the child be constantly exposed to sensory input that is intolerable to that child. Be aware that the child with autism may be burned but not remove his hand; may be cut, or injured, and not respond in a typical way.
Model: Do not over react to sensory-based behavior. Try to stay calm and help the child stay calm or become calm again.
6. Children on the autism spectrum may have less ability in the area of imaginative activity. Some of what seems “imaginative” may be ideas from books, videos and movies, and games.
Effects of reduced imaginative activity can include:
- Limited ability to imagine what is next or what will be different from the past (creates dependence on routines)
- Difficulty imagining what another person is thinking, feeling, or will do
- Problems with planning and carrying out plans
- Problems playing with toys or in games that require “pretending”
- Problems using novel imaginative ideas rather than re-enactment.
Understand: Reduced imaginative activity affects the child’s ability to predict the behavior of others and self-protect. It may affect the ability to “imagine” how to do a task or assignment and lead the child to appear noncompliant or inattentive. It interferes with pretend play. It can affect creativity and self-expression.
Teach: Teach ways to participate in pretend play that do not require as much imagination.
Support: Explain changes in advance; talk about the motivation of others. Allow the child to use preferred objects and object schemes during play.
Protect: Ask peers to help keep the child safe. Provide adult supervision in all child-controlled or child-mediated environments. Encourage others to play with the child with ASD.
Team: Objectively tell team members how reduced imaginative activity is affecting the child’s ability to learn, participate, play, and respond.
7. Executive function is the ability of the mind to make and carry out a plan. The “mind/body” connection allows us to make plans, carry out plans, move, start, stop, switch, and finish. Many children on the autism spectrum have less ability in the area of executive function.
Effects of reduced executive function abilities can include:
- Problems during both “small and large” transitions
- Seeming not to be paying attention
- Difficulty getting started working or stopping an activity at the request of another
- Difficulty making and carrying out plans, both simple and complex, and difficulty with fine motor or gross motor
- Getting “stuck” and having difficulty moving forward physically or mentally
- “Just sitting there” without getting started with work or play
- Difficulty organizing materials for a task
- Messy desk and locker
Understand: We use executive function skills every time we do anything! This area is very important to understand and address.
Teach: Use physical prompts and visual cues whenever possible because they are more easily learned and remembered than verbal cues. Avoid constant verbal cuing. Teach self-monitoring methods that the child can use across the lifetime. Use color codes, folders, bins, and boxes to help the child organize materials.
Support: Allow peers to provide some support as appropriate. Create routines to memorize.
Protect: Do not allow the child to be punished or penalized for not starting, stopping, switching, ending, or changing tasks. Be sure to provide adult support in activities during which lack of these skills could lead to danger.
Team: Objectively inform team members about the effects of limited executive function skills in your child care center, home, or other environments. Define what the child needs to learn to do/say.
Model: Use positive language and methods to help the child get on task, stay on task, complete tasks, and stay organized. Point out successes.
8. Central Coherence is the ability of the mind to take in, organize complex input, and provide an appropriate, immediate response. Children on the autism spectrum may have central coherence deficit—problems sorting through sensory input and responding well and quickly to new or changed environments.
Effects of reduced central coherence can include:
- Getting focused on the wrong details
- Seeming not to be paying attention
- Memorizing routines and schedules
- Having problems adjusting to changes in the environment
- Having problems with transitions, both small and large
- Having a shock or panic type of response to new environments or unexpected events
- Needing more time to get used to changes
- Needing more information about changes
- Needing time to process new environments or changes before the presentation of demands to perform
- Having trouble using a learned skill in a new environment or under new circumstances (problems with generalization)
Understand: Central coherence issues are most involved when the child has to take in and rapidly process new or rapidly changing stimuli or environments.
Teach: Teach self-supporting skills such as identifying what is new and taking time to “absorb” it before speaking or acting, or waiting next to a doorway instead of moving too quickly into a new place. Use color codes or other visual cues to show the most important aspects of an activity or event.
Support: Allow extra time to process. Decrease input to allow processing. Pre-teach new environments. Teach the individual to assess and choose the best location. Introduce change in increments with visual cues. Let the individual see changes happen. Plan to re-teach some skills in new environments if needed.
Protect: Plan to provide extra support when things are changing, especially if there is any potential danger such as traffic, strangers, or tools.
Team: Objectively describe the child’s behavior to the team. Ask team members to help prepare the child for new environments or activities.
Model: Try not to always be in a hurry. Model a slower, more aware pace. Freely, calmly provide assistance at times of change or confusion without penalizing or embarrassing the child.
9. Mind-sight is our ability to easily and automatically project and sense what another person thinks or feels just by looking at them or listening to them. Children on the autism spectrum may have mind-blindness—a reduced ability to automatically take the perspective of another and know that another person’s brain has different content from one’s own. This is sometimes referred to as “Theory of Mind.”
Effects can include:
- Not responding to the emotional content of the communication of others
- Not recognizing that others may have different likes, intentions, thoughts, feelings, or memories
- Seeming to not care about the feelings of others
- Appearing rude, insulting, uncaring, or aloof
- Missing communicative cues that indicate how the communicative partner wants us to respond
- Being easily hurt, victimized, sexually exploited, or bullied
- Not responding in an expected way to information conveyed in tone of voice, body language, gestures, or facial expression.
Understand: Children with autism do care about others. The problem is that they have a hard time automatically understanding and sensing the feelings and thoughts of others and giving a related response.
Teach: Tell the child what to do and say. Teach the child and others to seek help from supportive adults.
Support: Relate the feelings of others to the experience of the child with autism. Be sure therapies are addressing the child’s need to learn how to understand and interpret others.
Protect: Do not chastise, blame, punish, or embarrass the child. Ask peers to help keep the child safe. Provide adult supervision in all child-controlled or child-mediated environments.
Model: “Interpret” your feelings and underlying meanings for the child with autism. Willingly and calmly explain how others feel and what others think without sounding or being judgmental.
10. Most people can process new or familiar information rapidly and almost instantaneously. Delay in processing is a documented feature of many children with autism. Delays can vary from seconds to several minutes or longer.
The effects of delay in processing can include:
- Not responding when spoken to
- Seeming to be “noncompliant”
- Seeming not to be paying attention
- Staying on one subject while others have moved on
- Making what seem like off-task or off-topic comments
- Not starting or stopping at the request of another
- Appearing aloof, rude, or uncaring
- Not immediately following verbal requests
- Having problems processing new information while working to process what was already presented
Understand: Delay in processing affects response time and response content. Remember that the more input that is added, the less the child can respond to the original cue. So, say it once, and wait for a response.
Teach: Be sure that the child has an opportunity to learn and practice needed rapid responses for safety. Prioritize. Teach the child to let others know that more time is needed before responding, such as saying, “I’m thinking.”
Support: Allow the child to “get back to you” with an answer or response after a short delay. When possible, do not demand immediate answers or responses. Learn to use “structured waiting"—a great technique to use with all children.
Protect: Do not allow the child with ASD to be punished for not answering someone immediately or for not providing an immediate response.
Team: Ask team members to help teach and practice rapid responding for safety situations.
Team members should teach immediate responding to safety commands such as:
- Stop.
- Come here.
- Go outside now.
- Come in now.
- Give that to me.
- Walk with me.
- Move.
- Hurry.
- Wait.
- Wait here.
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