The Home Environment

Autism is a disorder that is very demanding on the entire family. Parents and siblings are faced with significant obstacles on a daily basis.

Living with an individual who has autism can be a source of stress for family members. Some of the sources of stress derive from the specific characteristics of autism and related pervasive developmental disorders. Communication and social deficits can be detrimental to the home environment and behavioral problems can affect every waking hour.

Many individuals with autism require care around the clock. Grooming and self care pose great challenges and sensory issues can make bathing and eating overwhelming obstacles on a daily basis.

Sleep problems are common among the autistic population. Some individuals may sleep excessively while others do not seem to sleep at all. Maintaining a daily routine in the home environment is challenging and keeping the many appointments for meetings, doctor visits and therapies can be overwhelming.

Safety awareness is a major concern for parents and caretakers of autistic children. Special consideration has to be made to ensure the autistic individual's safety because he is not always aware of the consequences of his actions.

With all of the stresses and challenges the family faces many look to processes like Wraparound for in-home therapeutic services. Wraparound is an approach that uses specific interventions to reach goals outlined in a treatment plan developed for the child.

Wrap Around in the Home

Wrap Around is a service that offers therapy for the autistic child in the home, school and community settings. Individuals who receive services will have a treatment plan that is developed in a collaborative effort between parents and professionals.

The treatment plan systematically outlines specific goals that the child is expected to reach. There are short term goals and long term goals listed under different categories according to the child's needs. Common goals include, but are not limited to, the following realms: communication, attention, compliance, social and play skills.

The child is typically assigned a case manager, behavior specialist and a therapeutic staff support member (TSS) who work as a team with the family. The Wrap Around services are family-centered and the involvement of parents and siblings in the process is of the utmost importance.

Communication

Much of the stress in the home environment revolves around the child's lack of communication skills. Developing ways to facilitate communication will help ease the stress greatly. Part of the focus when working with autism in the home environment is to find ways to express his wants and needs effectively.

Once the child is able to communicate effectively, there is greater chance that negative behavior and tantrums will decrease. Much of the negative behavior that is exhibited in the home environment can be linked to frustration and the inability to communicate.

Specific interventions that address communication deficits include sign language, the Picture Exchange Communication System and verbal cues.

• Verbal cues are direct and succinct, consisting of one or two words that are familiar to the child. Common verbal cues are: stop, wait, no, yes, more and all done.
• The Picture Exchange Communication System (PECS) has yielded great results in many home environments. Families can use the images to help the child transition and complete daily activities like bathing. The PECS can be used as a way for the child to initiate communication as well. The child simply exchanges a picture for the desired object. The PECS approach works well because it is concrete and visual in nature.
• Sign language is another visual approach that helps facilitate communication in the home environment. Sign language does require some gross and fine motor skills and will need to be taught systematically so the child makes a connection between the sign and the consequence for using the sign.
  

In some cases, families choose to use augmentative devices that aid in communication in the home environment as well. These mid technologies can be very useful in facilitation communication.

Compliance

Compliance in the home environment is an issue that many families with an autistic member face. Non-compliant behavior can be very challenging and it may escalate into negative behavior and tantrums. There are some strategies that encourage compliant behavior.

• A child may not follow through with directions simply because he has not processed the command. If a directive has too many words and is complicated the individual with autism is unable to process the information. He is unable to follow a direction that he has not processed.
• A spoken directive should contain as few words as possible. This will make processing the command much easier for the autistic individual. Using concise directions may feel a little strange or even rude at first but they are quite kind to the person with autism.
• Visual aids are extremely helpful in gaining compliant behavior. Using PECS as a means of giving directions is a great way to make the command visual. Gestures and sign language can be effective as well.
• The compliant behavior will most likely be repeated if it is rewarded. Using praise, treats or a preferred activity to reinforce the compliant behavior is a wonderful approach to encourage future compliance when the command is given again.
  
  

Dealing with Extreme Non-Negotiable Behavior

Some behaviors should not be ignored. Any extreme, violent behaviors are non-negotiable. Non-negotiable behaviors include any action that may cause self injury or injury to others as well as behaviors that may cause damage to property.

Planned ignoring and redirection do not adequately address these extreme negative behaviors but there are interventions that can be used in their place. There has to be an immediate and meaningful consequence to the non-negotiable behavior.

The treatment plan will include a crisis management section that is designed to address non-negotiable behavior. Common interventions include relocating the individual as well as your self to a new location. Move all items out of the child's reach and request a back up person to take control of the situation.

Sometimes the presence of the person who is the target of the non-negotiable behavior will immediately calm the autistic person. In the most extreme cases, physical restraint may be used.

Social Interaction and Play

All children learn through play. Play is a very motivating learning tool. However, children who have autism engage in unusual play activities. Engaging a child with autism in social integration and appropriate play can pose many challenges for families.

Many autistic children like to play in isolation. They engage in stereotyped repetitive movements and become enthralled with parts of objects. Imaginative play is not a natural form of entertainment or learning for the autistic child.

Some interventions can be used to encourage social interaction and appropriate play. One of the best approaches to take is to use the child's interests and integrate it into normal play. Greenspan's Floortime is an approach that does just this.

Floortime requires the parent to observe the child at play. The adult gradually joins the play activity always following the child's lead. The parent makes no demands but expands on the activity by adding different elements in the hopes that the child will build on that new element.

For example, a child with autism likes to put cars in a line. The parent observes the child's activity and begins to put cars in the line going in another direction. The child adds cars to the parent's new direction.

Using toys that have appeal to the senses is a great way to motivate an autistic child to reciprocate play in the home environment. Bubbles, tickles and swinging are wonderful sensory activities that encourage the child to use communication and reference the other player.

Sensory Issues

Everyone has some sensory issues. Some people dislike a certain fabric or the well-known sound of fingernails running down a chalkboard. People with autism have sensitive sensory systems in many cases.

No two individuals are exactly alike. Some individuals with autism may love the feeling of water while others can't stand to even listen to the sound of water filtering into a bathtub.

The sensory issues pose a challenge for everyday activities like grooming and meal time. Many people with autism have sensory issues that make some food textures intolerable and brushing teeth unthinkable.

Respite

Occasionally, families need a break from their autistic relative. Respite is a service that helps families take some time away from the individual with autism. The services can be provided in the home environment or the individual may visit a facility for the day or overnight.

Respite goes beyond babysitting services. The respite care worker is trained to use interventions designed for the treatment of autism. The individual is engaged in play and therapeutic activities while in respite care.

Self Help Skills

The goal of most interventions in the treatment of autism and related pervasive developmental disorders is to help the individual gain independence. Self care can be challenging for some people with autism for a number of reasons.

Many individuals with autism need help with activities that require fine motor skills. Fine motor skills are necessary to complete everyday activities like buttoning a shirt or closing a zipper. These tasks require hand-eye coordination, attention and some patience.

Many individuals who have autism attend occupational therapy sessions that are designed to develop fine motor skills and gross motor skills. However, families can encourage fine motor activities throughout the day. There are plenty of options that promote these skills.

Play Doh(R) is a wonderful tool for developing fine motor skills. The activity is often rewarding in itself and it can also be used as a tool for interaction as well as communication. Other fine motor activities include drawing, typing, lacing string and anything that requires some dexterity.

Self help skills also face another great obstacle that many individuals with autism have. Sensory issues can be detrimental to the efforts of completing self care activities.

For example, a child may not tolerate the feeling of a brush or comb in his hair. The intolerance is not due to non-compliance. It is often due to sensory issues.

Negative Behavior

Negative behavior comes in many forms for many reasons. Finding the reason behind the behavior will help but playing a guessing game while the child is having a tantrum does little good for anyone involved.

Quickly redirecting negative behavior can be an effective way to smother the behavior in the home environment. Redirection simply involves moving the child's attention in a completely different direction. There is no argument or mention of the negative behavior. the focus is on the new activity.

Planned ignoring is a method that sends a powerful message to the individual with autism. There will be no feedback provided for negative behavior. This approach needs to be used consistently to be effective and the negative behavior may not disappear right away but it will in time.

Some negative behavior can not be redirected or ignored. These are non-negotiable and include any behavior that will cause injury to self or others or damage property.

Many families devise a reward system that uses tokens or stickers to help the autistic individual recognize positive and negative behaviors. Removing a token or taking away a preferred play activity from the schedule are consequences for non-negotiable behaviors.

Some negative behaviors are too violent to be ignored and most consequences do little to stop the behavior. Sometimes crisis interventions need to be used.