Maintaining Skills For Children with Autism During COVID-19

By Ronit Molko, PhD, BCBA-D

The Covid-19 response requiring nationwide social distancing and sheltering in place has curtailed or eliminated opportunities for one-on-one or group ABA activities in centers and schools. That has left many parents of children on the autism spectrum wondering how to maintain the gains their children have made in ABA therapy. Because the current conditions will almost certainly persist into late Spring and possibly beyond, we want to help parents adapt to these new conditions as soon as possible.

Maintain Structure

The current situation is obviously sub-optimal, but there are strategies parents can employ to sustain their children’s forward momentum. The first is to recognize that the current measures represent a drastic disruption in the child’s routine and that establishing a new routine as soon as possible is important. This routine should adhere as closely as possible to the existing home-school routine with which the child has become comfortable. We all need some level of structure to function well- structure provides emotional safety as well as freedom.

Utilize Telehealth

Although the effort to minimize human-to-human contact has taken in-person ABA services off the table in many communities, many behavioral health providers are moving to telemedicine and online services using video conferencing and video calling apps. The number of these is expected to grow in the first few weeks of sheltering at home, so parents should access their providers for remote support and guidance.

Opportunities to Use ABA

ABA therapy is a repetitive command-response-reward learning system that develops a variety of skills, including communication, hygiene, play, sharing and other activities of daily living. They can be reinforced with everyday activities within the the new home-life routine.

Morning Routine

The morning routine might not have to vary at all, even without school. The child still must wake, wash, dress, brush teeth and eat breakfast, in the same order and at the same time as before. Parents should emphasize to their children the importance of personal hygiene and this is an excellent opportunity to teach the hand-washing and tooth brushing phases of this routine.

If the child normally has the option to choose what they want for breakfast, parents should maintain that choice and require the child to communicate it as before, and be rewarded with the option they choose. Veering off these routines can cause distress for children with autism.

Learning While Having Fun

It’s important to remember that many skills can be taught during typical daily activities and routines at home, as well as during times of play and fun. For example, baking together with your child provides the opportunity to teach and practice math, follow directions (a recipe) and the daily living skills of cleaning up.

Communication

Communication, playing and sharing skills can all be reinforced through play, for which there are myriad options even from home. Scholastic magazine offers free online lessons “built around a thrilling, meaningful story or video,” according to its website. These lessons can be adapted for children with autism and completed at the child’s pace. Scholastic will release 20 weeks of lessons designed to take three hours apiece.

Virtual Excursions

Various zoos now offer live video online of animals in their habitats. Discussion and play can be developed around the identities of the animals, the sounds they make and what the child can see them doing. Among the zoos with webcams are the Smithsonian in Washington, D.C., Seattle, Houston, San Diego, Maryland and Memphis. The penguin exhibit at the Kansas City Zoo is particularly fun and active.

Creativity Time

Art activities help children express their creativity while exercising some of their learned skills. Collaborative projects among children can be used as a springboard to practice sharing and communicating. Parents can focus on tactile art projects that fit the needs of their child, using household items like food dye, macaroni, sponges, shaving cream, toilet paper rolls and much more.

Make Time for Play

There are many other play activities that parents can employ to engage children with autism (and neurotypical children!) and reinforce the skills they have learned in therapy. These might include board games, exercise and sports, and computer games. Whatever the activity, communication with the autistic child should make clear what is expected and reward constructive responses.

Lunch and Dinner

Lunch and dinner times and routines should be maintained while the child is home. Involving an older autistic child in food preparation is a way to develop life skills while practicing sharing, communication, etc. Bedtime routines should be strictly maintained for the emotional comfort of the child.

Parents are their children’s first teachers and continue in that role for their entire childhoods. With a little creativity, parents of children with autism can find enjoyable, everyday moments to reinforce their children’s lessons from therapy.

Crisis Support for Families

By Rebecca Mandal-Blasio, PhD, BCBA-D

It is Thursday morning and I just received the 4th frantic phone call from a family member of a child with autism. These are parents who are desperate to find crisis services for their child. These are not families who already have our ABA services, these are family members who did not have any services. Others were on waitlists to receive ABA, and sadly others’ ABA providers hav closed their doors during this time. As I talk to these family members, I refer them to agencies I hope can help, but the reality is crisis services for children with autism are often hard to find even when there is not a pandemic occurring.

So what can families do whose children are not use to the major disruption to their routines due to their school or learning center bing closed and added the social disruptions caused staying at home and social distancing? The limited explanation or understanding about why these changes have occurred can lead to stressful feelings that may manifest as irritability, tantrums, aggression or self-injury. Ultimately, family members understandably become fatigued and frustrated as they do the best they can in a hectic situation.

Here are a few tools/tips to best support and guide your family during this time and  to help prevent crisis from occurring.

  1. Explain what is currently happening: Children need to know why there are closures or why they can not go outside. Keep it as simple as possible, but explain in concrete terms….in black and white. Having “gray explanations” and using abstract words or concepts will only make a confusing situation worse.

  2. Social Stories: Often times ABA therapists and families utilize social stories to help explain stressful situations such as going to the dentist or getting a haircut. A social story could be a useful tool in explaining what, how and why they can not leave the house and go to the park they used to go to every day. Many autism websites will help provide tips on how to write these stories that could be reviewed each day. If your child is able to assist you with writing a social story, it is great opportunity for an afternoon activity too. Click here for example.

  3. Try to keep a schedule: This may be hard to do given our schedules are not predictable each day, but making the child’s schedule as predictable as possible will help calm stressful feelings. This can be accomplished by using a visual or word schedule to make their routine predictable. As the child completes one activity have them put the picture in an envelope or cross the activity off of the paper. Helping set up a schedule for your child will also help put a routine in place for you as well. Ideally, this would as similar as possible to the schedule the child had before the restrictions of the COV-19 were in place (i.e., wake and bed times, bath times, eating times). Don’t put pressure upon yourself to create an elaborate schedule. A simple schedule will be just as effective. If changes need to happen in the schedule, review the changes with your child to prepare them that their routine won’t be as predictable on that particular day.

  4. New Skills: New skills may need to be taught using task analysis. For example, hand washing more frequently, the new way to greet people with out shaking hands, using hand sanitizer, or keeping 10 feet away from others may be new skills that should be taught during this time. Breaking these activities into smaller steps and rewarding each step completed will lead to the child learning these new skills. Choosing their favorite song to wash their hands to or setting a timer to indicate when they can stop washing should be considered. Again, no pressure on creating these task analyses….there are many websites that are available for free to help parents create these during this event. Click here for example.

  5. Everybody needs a break: Down time is a good thing for everyone. Watching a show on tv or tablet, reading a book, counting beads, or taking a nap is necessary for all of us during stressful times. Exercise or going for a walk outside are also good activities. Down time allows us to escape from the stress and recharge ourselves so that we can face the new activities of our lives.

  6. Identifying triggers: You might be aware of the regular triggers that upset your child, however, new triggers during this time may be developing. Observing your child to see what triggers or antecedents proceed challenging behaviors will be vital in decreasing stressful times in your household. If you can identify these triggers, remove or minimize them around your child. But sometimes this is not possible which leads to #7.

  7. Coping skills: Determining the activities or skills your child has to self-manage or calm themselves down will be a must in at this time. Counting to 10, deep breathing, touching a sensory item, or behavior relaxation are some ways children have been taught coping skills. If your child does not have coping skills, having a quiet place to calm down will be necessary. A dim room, maybe a circulating fan for a cool breeze, soft relaxing music, access to sensory calming items may be used to create the perfect calm place. The quiet place needs to be individualized for your child’s preferences and what he or she finds relaxing.

Where to Access Help in a Crisis
  1. State agencies: Many states have agencies that specifically work with individuals with developmental disabilities. These agencies have psychologists who have experience in providing behavioral services. Often they have crisis teams that work in conjunction with mental health agencies that can help during dangerous or extremely stressful times. Local parent groups can often be great resources for this type of information, like this example from the Phoenix Autism Society website. 

  2. Mental Health Clinics: If your child is currently being seen by a psychiatrist, the psychiatrist should be notified that a crisis is occurring. Emergency office visits or telehealth appointments can be set up to get medication guidance during this times.

  3. If a child is an imminent risk to themselves or others, hospitalization may be unavoidable. Working with a psychiatrist will help you in locating in-patient mental health services. Child specific hospital emergency rooms may not have as many COV-19 emergencies that can assist if hospitalization is necessary.

Know that you don’t have to do it all alone.  Connect to family and friends when possible or with other parents on community pages on social  media.  With support and quality resources, you will get through this challenging time and back on track.

Regulating Your Emotions During COVID-19

By Katherine Johnson, BCBA

Until recently, my weekdays had a different form of routine to them.  Each morning my family and I would venture out to spend our day at work or school, and look forward to the time when we would get to connect later in the day. I love coming home to my kids. After a long workday or a good yoga class, there’s nothing better than collapsing on the sofa with them to read a new book or review the day. But suddenly, I’m not coming home to them – I’m with them all day, every day, as we adjust to the strange new world of Covid-19. My kids aren’t coming home to me, either – no more playdates, sports practice or outing with friends.  We’re together all the time, at home and sometimes outdoors. And suddenly we realize how much we all rely on those shifts in company and locations to help regulate our emotions.

Whether you are sheltering in place, on a stay at home order, or just practicing social distancing, changing our surroundings (and people surrounding us) is not as simple as it was a few weeks ago.  Without being able to take off when things get tense, how do we manage our emotions in this new landscape?      

1. Accept and acknowledge your emotions

When you’re overcome with overwhelming irritation or sadness, take a deep breath and remember the emotions are conveying important information.  Learning to work with, and not against, our emotions is important. Studies show that even just acknowledging the emotion – I’m frustrated, I’m frantic – helps diffuse its energy. Say it to yourself. Say it to the other person in the room.  No need to ascribe a reason to it – “I’m feeling frustrated,” is a great way to share your own experience.  “I’m frustrated because of the mess in the kitchen” can be less helpful as takes the focus of your internal emotions and places it on something external (the kitchen).

2. Observe your reactions

Once you’ve named your emotion, is it urging you to act? An emotion-fueled action can be useful or not, depending upon the circumstances – grabbing your child out of harm’s way in response to fear of the coming car is different from yelling at a child over dirty plates left on the table. 

Observing your emotional state and the resulting urges is an important practice. After you name your emotion, do a quick body scan; notice where your muscles are tense, what sensations you are experiencing.  Notice any urges you are feeling; are you about to yell? To say something cutting? Pausing to observe your reactions and resulting urges, buys you time to consciously decide if you will act on them or defuse them.  

3. Influence Your Emotions

So now I’m frustrated and angry at the mess the kids made when I was in the other room. My body is tense, my neck is beginning to ache and I have the urge to yell at them, order a cleanup, and share some of the discomfort! 

But what do I actually want to do? Should I lean into the anger, intensifying it, so they may think twice before dumping the entire puzzle box in the lego bin again? Or should I diffuse my anger by deliberately seeking more compassionate responses. like remembering they are just kids, they are frustrated and cooped up, and sorting it out will be a good learning experience? 

If I pause and observe, I can choose my response deliberately.

4. Take control of your urges

Emotions often cause us to act – but the opposite is true as well. Actions also influence our emotions.  When you are feeling an emotion you want to change, experiment with actions that are the opposite of the urge. When you are angry and want to say something biting, a conscious choice to use gentle words will help subdue your anger.  When you are feeling guilt and are inclined to avoid talking about it, speaking openly about the incident and apologizing can relieve your guilt.  And when you can’t adjust your tone or words, take a moment for a deep breathe or a walk, or a few seconds in another room. 

5. Respond to unhelpful thoughts 

The emotionally-driven thoughts that flow during times of fear and anxiety often reinforce those emotions – unless we can take some control, it’s easy to fall into black and white thinking, catastrophizing, or over-personalizing.  (“This is how the kids always do this!” ”No one respects my efforts to keep the house clean.”  This is another place where pausing and observing helps – it gives you time to remember that thoughts are not facts, and what looks like reality may shift as your emotional state quiets down. Put those thoughts on hold for the moment and promise to revisit them later. When you are calmer, test your thoughts: are they aligned with the facts on the ground? Are they helpful?  

6. Practice mindfulness

Mindfulness activities are things you do to promote your conscious awareness of the present moment.  They can be centering and calming, something that everyone needs in uncertain times. Yoga and meditation are wonderful and there are a multitude of online yoga classes and meditation podcasts.  If yoga or meditation aren’t your thing, there are countless other activities to promote mindfulness.  Here are a few: 

  • Sit quietly for a few minutes and observe an object (a leaf, a mug, a lego creation).  Give it your full attention, noticing the texture, the colors, the shape.
  • Close your eyes and pay attention to your breathing.  Try inhaling for a count of ten, holding your breath for a count of ten, exhaling for a count of ten.    
  • Look out a window and try to observe the shapes and colors of things without labeling the objects in your mind.   
  • Listen mindfully to another person; focus only on what they are saying.  If your mind begins to formulate a response, gently re-focus yourself on the other person.

Practice mindful eating.  Before taking a bite, observe the color, texture, shape, and smell of the food.  While taking a bite, notice the feel of the food in your mouth, the taste, the sensation of the temperature of the food. 

The changes brought about by Covid-19 will pass but there will certainly be other circumstances in our future that affect our expectations of how things should be in contrast to how they are.  By practicing awareness of your emotions and consciously steering your reactions, you can build skills that will benefit you and your family far into the future.