!WAVE%Program%–%Including%Individuals%with%Autism%!

1" www.waveottawa.ca"!!!!!!!2014!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Sheila!Bell,!Speech0Language!Pathologist!

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What"is"Autism?"

Autism!is!a!complex!neurological!difference!in!the!way!that!the!brain!processes!and!responds!to!information!–!this!difference!presents!challenges!as!well!as!intellectual!gifts.!

What!we!refer!to!as!“autism”!is!actually!a!spectrum!of!diagnostic!profiles,!referred!to!as!“Autism!Spectrum!Disorders”!or!ASD!for!short.!People!who!receive!a!diagnosis!on!the!Autism!Spectrum!show!differences!in!the!development!of!verbal!communication!and!social!interaction.!ASD!individuals!may!be!verbal!or!nonBverbal!(or!somewhere!inBbetween),!and!most!have!significant!difficulty!processing!spoken!language!“at!speed”!in!daily!communication!situations.!Social!interaction!is!complicated!by!difficulty!reading!and!processing!social!"cues"!(facial!expression,!body!language,!voice!tone).!People!on!the!autism!spectrum!may!also!display!unusual!behaviours!(flapping,!rocking)!and!sensory!differences!(hyperBsensitivity).!ASD!individuals!are!often!resistant!to!change!and!can!become!quite!distressed!when!routines!are!altered!and!unexpected!events!occur.!

Autism!is!diagnosed!using!a!“checklist”,!and!as!a!result,!there!is!a!great!diversity!within!the!ASD!population.!To!be!successful!interacting!with!and!teaching!ASD!individuals,!you!will!need!to!be!observant!and!flexible,!paying!attention!to!the!specific!individual!in!front!of!you,!and!using!a!set!of!basic!principles!to!guide!you!in!choosing!effective!teaching!techniques.!!

Over!the!last!few!decades,!starting!with!Temple!Grandin,!multiple!first0person!accounts!by!

verbal!ASD!individuals!have!given!valuable!insight!into!their!unique!perspective!and!thinking!

style.!These!accounts!are!important,!because!understanding!what!autism!is!like!from!the!

inside!changes!the!way!we!deal!with!the!challenges!of!autism!from!the!outside.!But!these!

accounts!still!leave!unanswered!questions!–!what!about!the!large!portion!of!the!ASD!

population!who!remain!at!a!non0verbal!or!low!verbal!level?!

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More!recently,!a!small!but!increasing!number!of!non0verbal!ASD!individuals!have!been!able!to!

use!written!language!and!drawing!to!present!their!point!of!view,!revealing!sharp!intellects!

behind!the!lack!of!speech!and!unusual!behaviours.!Clearly!not!being!able!to!communicate!by!

conventional!means!is!not!the!same!as!not!thinking!or!having!nothing!to!say.!

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!WAVE%Program%–%Including%Individuals%with%Autism%!

2" www.waveottawa.ca"!!!!!!!2014!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Sheila!Bell,!Speech0Language!Pathologist!

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Respect"the"Autism"Perspective:!!

Remember!that!you!are!dealing!with!bright!people!who!have!their!own!likes!and!dislikes,!skills!and!talents,!as!well!as!neurological!differences!which!can!present!challenges!dealing!with!daily!life!in!a!chattering!social!world.!Work!with!the!differences,!not!against!them.!Seek!to!understand!the!reasons!behind!the!unusual!or!difficult!behaviours.!Adjust!your!communication!and!social!style!to!match!the!person!you!are!teaching.!These!are!great!people,!and!you’ll!be!happy!you!took!the!time!and!made!the!effort!to!really!reach!and!teach!them.!

Creating"an"“Autism"Friendly”"Environment:"

1."Physical"Environment"&"Sensory"Sensitivities"(and"allergies):"

9 Consider!lighting!in!your!recreation,!work!&!education!spaces!–!fluorescent!lights!may!be!too!harsh!and!may!have!an!audible!buzz!(for!sensitive!individuals)!–!sunlight!is!too!bright!for!some!ASD!individuals!(they!may!need!dark!glasses,!limited!outdoor!activities,!“shady!escape”)!–!environments!with!flashing!lights!and!fluorescent!glowBinBtheBdark!paint!(think!“Rock!&!Bowl”)!may!be!overBwhelming!for!some!ASD!people!–!some!will!have!difficulty!in!dark!or!dimly!lit!spaces!(especially!if!they!count!heavily!on!visual!information!to!figure!out!the!world)!

9 Consider!background!noise!(both!mechanical!and!human)!–!remove!as!many!extra!background!sounds!as!possible!(fans,!loudBspeakers,!traffic!noise,!crowd!noise)!–!quieter!spaces!are!usually!better,!smaller!groups!are!easier!–!extremely!noise!sensitive!individuals!might!benefit!from!having!the!choice!to!wear!noiseBcancelling!overBtheBear!headphones!(you!can!find!these!at!home!improvement!stores!like!Home!Depot)!

9 Certain!textures!and!touches!will!be!aversive!to!some!ASD!individuals!–!if!an!ASD!person!can’t!stand!the!feeling!of!some!of!the!equipment!(e.g.!wet!lifeBjackets,!scratchy!pool!noodles)!problemBsolve!with!the!family!to!see!what!equipment/materials!might!work!as!a!substitute!!–!don’t!force!the!person!to!wear!or!touch!something!that!feels!“wrong”!to!them!

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!WAVE%Program%–%Including%Individuals%with%Autism%!

3" www.waveottawa.ca"!!!!!!!2014!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Sheila!Bell,!Speech0Language!Pathologist!

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9 Pain!responses!may!be!unusual!–!the!ASD!person!may!be!hypersensitive!and!show!a!severe!reaction!to!a!“small”!hurt!(e.g.!a!cut!or!scrape)!or!may!be!hyposensitive!and!not!react!to!a!“large”!or!dangerous!injury!(e.g.!might!walk!on!a!broken!ankle)!–!the!same!individual!can!show!both!hyper!and!hypoBsensitivity!to!pain!

9 some!ASD!individuals!have!severe!environmental,!food!and!seasonal!allergies,!which!may!be!expressed!in!behavioural!&!cognitive!changes!(see!Doris!Rapp’s!book!“Is!this!your!child?”!for!more!detailed!information)!–!when!you!see!a!sudden!disintegration!of!behaviour,!this!may!be!the!underlying!cause!

9 ask!the!family!about!allergies!on!your!intake!forms!and!do!your!best!not!to!expose!the!person!to!substances!they!are!sensitive!or!allergic!to!–!make!sure!you!have!an!emergency!contact!number!in!case!of!accidental!exposure!

9 in!general,!avoid!the!use!of!scented!personal!care!products!(perfumes,!body!lotions,!shampoo/conditioner),!monitor!recreation,!!work!&!education!spaces!for!mold/mildew!and!dust!buildBup,!and!avoid!taking!sensitive!individuals!into!newly!renovated!spaces!(where!building!materials!may!still!be!offBgassing)!

2."Personal"Characteristics"&"Interaction"Style"

9 you!can!make!yourself!a!more!“Autism!Friendly”!person!9 let!the!ASD!person!“meet”!you!by!photo!or!video!before!they!see!you!in!person!(put!your!

printed!name!with!the!picture)!–!the!first!faceBtoBface!meeting!should!be!oneBtoBone,!rather!than!in!the!middle!of!a!group!(this!can!be!part!of!your!intake!protocol)!

9 watch!your!voice!volume!–!loud!enough!to!be!heard,!but!not!so!loud!that!you’re!overBwhelming!(note:!some!ASD!individuals!will!do!better!with!female!than!male!voices,!or!vice!versa!!–!this!is!not!personal,!it’s!a!processing!issue)!

9 watch!the!reactions!of!the!ASD!person!to!figure!out!how!close!is!comfortable!and!how!close!is!too!close!(if!they’re!backing!up,!you’re!too!close)!

9 similarly,!watch!the!reaction!to!your!facial!expressions!and!gestures!–!some!individuals!will!do!well!with!highly!animated!instructors/supervisors,!while!others!will!respond!better!to!a!calmer!less!demonstrative!teacher!(match!the!individuals!to!the!instructors,!change!up!your!style!to!match!the!ASD!person)!

!WAVE%Program%–%Including%Individuals%with%Autism%!

4" www.waveottawa.ca"!!!!!!!2014!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Sheila!Bell,!Speech0Language!Pathologist!

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9 DO!NOT!require!eye!contact!–!some!ASD!individuals!cannot!listen!and!look!at!the!same!time,!others!have!extreme!difficulty!processing!faces!(to!the!point!where!looking!at!a!human!face!can!be!aversive),!others!are!choosing!not!to!make!eye!contact!for!the!same!reasons!you!would!(discomfort,!wanting!to!end!an!interaction)!–!let!the!ASD!person!choose!when!to!look!

9 make!yourself!predictable!–!develop!small!interactive!routines!with!each!ASD!person!(e.g.!maybe!they!like!knock!knock!jokes!so!you!always!start!the!class!or!work!day!with!that!type!of!joke,!maybe!they’re!a!hockey!fan!so!you!always!start!your!interaction!with!a!quick!discussion!of!the!latest!hockey!news)!

9 dangly!jewelry!and/or!strong!scents!(personal!care!products)!can!overwhelm!sensitive!individuals,!so!don’t!wear!these!to!work!

9 it!will!be!obvious!to!the!ASD!person!whether!you!truly!like!them!,!appreciate!their!differences,!and!enjoy!their!company!–!true!respect!and!liking!is!the!most!important!characteristic!you!can!bring!to!working!with!ASD!individuals!

3."Language"&"Communication"

9 know!how!the!ASD!individual!communicates!(verbal,!nonBverbal,!use!of!typing!or!pictures)!–!this!is!a!critical!part!of!your!intake!process!–!if!this!is!a!recreation!or!work!setting,!you!are!not!typically!responsible!for!developing!a!communication!system,!but!you!must!make!sure!you!use!the!communication!system(s)!that!the!ASD!individual!already!uses!in!other!environments!(home,!school)!–!that!includes!making!sure!any!special!communication!equipment!(e.g.!iPad,!picture!board)!is!available!in!the!recreation/work!environment!and!that!staff!are!familiar!with!the!basics!

9 in!general,!be!kind!and!direct!and!say!what!you!mean!in!simple!language!9 speak!slowly!and!“chunk”!information!–!use!visuals!to!backBup!key!spoken!information!9 non0verbal!social!communication!cues!(like!facial!expression,!voice!tone!and!body!

language)!will!frequently!be!missed!–!say!directly!what!is!usually!not!explained!(e.g.!“this!is!a!joke!….!“!or!“I’m!not!angry,!I!just!have!to!speak!loudly!because!we’re!outside”)!

9 avoid!sarcasm!(where!decoding!“tone!of!voice”!is!critical!to!understanding!the!true!meaning)!

9 slow!down!and!give!the!ASD!person!time!to!think!and!respond!(especially!if!they!are!nonBverbal!and!using!a!communication!device!–!it!takes!longer!to!type!than!to!speak)"

!WAVE%Program%–%Including%Individuals%with%Autism%!

5" www.waveottawa.ca"!!!!!!!2014!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Sheila!Bell,!Speech0Language!Pathologist!

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4."Visual"Supports,"Structure"&"Routine"

9 most!ASD!individuals!will!benefit!from!having!information!put!into!a!visual!format!–!the!major!advantage!of!visual!information!is!that!it’s!stable!and!can!be!studied!over!time!(without!the!original!information!changing!or!decaying)!

9 also,!most!ASD!individuals!do!best!when!life!is!predictable!–!having!definite!structure!and!routine!to!activities!and!schedules!of!activities!or!work!tasks!will!help!create!a!calm!environment!for!new!learning!and!experiences!

9 Social!Stories!–!these!can!be!traditional!written/picture!stories!or!they!can!be!videos!–!social!stories!can!give!positive!information!about!what!to!expect!in!a!new!environment!–!by!reducing!the!element!of!surprise,!they!prepare!the!ASD!individual!to!calmly!negotiate!a!novel!situation!

9 Visual!“walk0throughs”!will!be!helpful!in!reducing!stress!(initially,!you!can!send!pictures!or!videos!of!the!recreation,!education!or!employment!building/space,!then!have!the!ASD!individual!come!through!for!a!1BtoB1!tour!before!the!first!day!of!class!or!work)!

9 Visual!Schedules!are!important!to!help!ASD!individuals!know!what’s!happening!next!and!what!to!expect!(verbal!information!is!often!missed!in!group!situations)!–!changes!to!the!normal!routine!should!be!clearly!(and!visually)!marked!on!the!schedule!!

9 Visual!“Jigs”!are!instructions!in!visual!format!(like!a!picture!“recipe”)!that!give!stepBbyBstep!numbered!instructions!for!how!to!do!a!novel!activity!or!work!task!

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!WAVE%Program%–%Including%Individuals%with%Autism%!

6" www.waveottawa.ca"!!!!!!!2014!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Sheila!Bell,!Speech0Language!Pathologist!

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6."Time"Pressure"&"Transitions"

9 changing!from!one!activity/task!to!another,!or!from!one!physical!space!to!another!can!be!challenging!for!an!ASD!person!

9 give!“count0down”!type!warnings!marking!the!amount!of!time!left!until!an!activity!is!over!–!visual!timers!can!help!to!make!this!more!obvious!to!an!ASD!individual!

9 structure!your!recreation!or!employment!time!to!reduce!the!number!of!transitions!9 ask!the!family!(during!intake)!about!effective!strategies!they!use!at!home!to!help!the!ASD!

person!disengage!from!one!activity/place!and!move!to!another"""

Managing"Crises"&"MeltQdowns:"

Individuals!with!Autism!experience!stress!and!anxiety!on!a!daily!basis.!This!high!stress/anxiety!level!can!become!obvious!as!loud!and!difficult!behaviour.!Common!sources!of!stress!and!anxiety!include:!

9 Difficulty!following!a!communication!exchange!or!social!interaction!“at!speed”!9 Inability!to!predict!what!will!happen!next!(breaking!routine!without!warning)!9 Time!pressure!9 Closing!one!activity!and!starting!another!(especially!if!first!task!is!not!complete)!9 Sensory!overload!(background!noise)!9 Too!many!people!9 Task!is!too!hard!and/or!not!understood!9 Exposure!to!problematic!allergens!(including!“seasonal!disintegration”)!9 Measurement!of!performance!(winning!&!losing)!9 Subtle!(not!seen!by!instructor/job!coach)!bullying!by!other!children/adults!9 Specific!(idiosyncratic)!fears!&!phobias!

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!WAVE%Program%–%Including%Individuals%with%Autism%!

7" www.waveottawa.ca"!!!!!!!2014!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Sheila!Bell,!Speech0Language!Pathologist!

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Strategy"#1"–"Know"the"individual’s"triggers"and"signs"of"“stress"rising”"

Here!are!some!examples!of!“stress!signs”!(note:'this'is'another'question'to'ask'at'intake)'

9 Tics!&!repetitive!behaviours!(eye!blinks,!facial!grimaces,!nose/throat!noises,!body!movements)!

9 Language!“scripting”!(repeating!lines!from!TV/movie!or!previous!personal!negative!scenario)!

9 Distressed/angry!facial!expression!9 Loud!laughter,!rising!voice!volume!

Strategy"#2"–"Have"a"“Safety"Plan”"for"meltdown"situations"

9 Designate!a!“safety!spot”!(or!several!spots,!especially!if!you!are!working!in!a!large!or!multiBlevel!building!–!think!through,!ahead!of!time,!potential!“safe!spots”!for!offBsite!trips)!

9 “Safety!Spot”!should!be!quiet,!!have!enough!room!for!ASD!person!to!move!around!comfortably!(without!having!to!be!too!close!to!other!people),!and!be!selfBcontained!(limited!exit!points)!

9 ASD!individual!should!know!ahead!of!time!about!the!“safe!spot”!and!be!clear!that!it!is!a!“calm!down”!place,!not!a!punishment!(this!is!not!“time!out”)!

9 Write!out!the!“safety!plan”!in!language!and!pictures!for!the!ASD!person(social!story)!!–!identify!their!“safety!people”,!let!them!know!what!will!happen!when!they!are!upset!and!need!support!(the!routine!or!protocol),!give!them!a!way!to!let!you!know!that!a!situation!is!deteriorating!and!they!need!help!(e.g.!an!emergency!“break”!card,!“help”!card!or!“get!me!out!of!here!”!card)!

9 When!an!ASD!person!is!in!“meltdown”,!they!do!not!have!access!to!their!usual!

communication!skills!–!keep!language!to!a!minimum,!maintain!a!calm/neutral!face!and!voice!tone!–!what!looks!like!anger!is!really!distress!–!it!may!help!to!dampen/change!your!own!automatic!emotional!responses!by!imagining!the!child/adult!crying!(so!that!your!response!becomes!calming/soothing!rather!than!pumped!up!by!adrenaline!to!fight/flight)!

9 Main!goal!is!to!let!the!ASD!child/adult!calm!down!(while!keeping!everyone!physically!safe)!

!WAVE%Program%–%Including%Individuals%with%Autism%!

8" www.waveottawa.ca"!!!!!!!2014!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Sheila!Bell,!Speech0Language!Pathologist!

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9 If!it!is!impossible!to!move!the!ASD!individual!safely,!then!clear!others!from!the!physical!space!where!the!upset!is!occurring!(turn!that!into!a!temporary!“safe!spot”)!

9 Calm0down!routines!and!strategies!will!be!different!for!each!ASD!person!–!talk!to!family!to!find!out!details!of!what!works!and!ask!them!to!help!you!obtain!any!specialized!equipment!necessary!(e.g.!weighted!vests,!headphones,!dark!glasses,!etc.)!

9 Key!staff!should!have!detailed!information!about!the!safety!plan,!and!should!have!layers!of!backBup!plans!(plan!A,!B,!C,!etc.)!so!that!the!plan!can!be!quickly!adapted!to!multiple!environments!and/or!sudden!escalation!of!distress!presenting!in!an!unforeseen!way!

9 All!staff!(including!support!staff)!should!know!the!ASD!individual!by!sight!and!have!

basic!information!(e.g.!“this!child!should!always!be!accompanied!by!an!adult,!so!if!you!see!him!on!his!own,!please!notify!key!staff!immediately!and!follow!him!at!a!safe!distance!to!be!sure!he!stays!safe!–!don’t!interfere!directly!unless!he!heads!toward!an!outside!exit!door”)!–!this!can!be!set!up!in!the!same!way!as!you!would!alert!staff!to!lifeBthreatening!allergic!reactions!

∗ REMEMBER:!there!is!always!a!flight!risk!(even!with!ASD!individuals!who!have!

never!run!away!from!a!group!before),!so!have!an!“emergency!search”!protocol!

in!place!as!well!

Strategy"#3"–"Later"meet"to"problemQsolve"(possible"causes,"plan"for"next"time)"

- look!at!the!context!of!the!behaviour!(what!happened!just!before,!at!the!same!time,!just!after)!

- make!a!"best!guess"!about!the!source,!then!make!changes!based!on!that!guess!(e.g.!if!you!think!the!task!is!too!hard,!try!modifying!the!task!requirements,!on!the!other!hand,!if!you!think!the!noise!level!in!the!class/group!is!too!high,!you!might!try!creating!a!quieter!oneBtoBone!teaching!or!work!spot)!

- verbal!ASD!individuals!may!be!able!to!tell!you!what!the!problem!was!after!they’ve!had!a!chance!to!calm!down!

- if!signs!of!stress!lessen!with!the!changes!you!make,!you're!on!the!right!track;!if!stress!level!remains!the!same!or!rises,!you!need!to!look!at!the!situation!again,!and!see!what!else!might!be!causing!the!person’s!distress!

!WAVE%Program%–%Including%Individuals%with%Autism%!

9" www.waveottawa.ca"!!!!!!!2014!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Sheila!Bell,!Speech0Language!Pathologist!

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…!in!summary,!please!remember!…!

NO!SURPRISES!!Be!kind!&!direct.!Slow!down!&!use!visuals!to!back0up!key!information.!

Stay!calm!&!don’t!take!difficult!behaviour!personally.!Don’t!be!shy!to!ask!for!back0up!.!!

Always!consider!&!respect!the!ASD!perspective!0!successful!outcomes!require!work!on!

both!sides!of!the!“social!equation”!(the!ASD!person!should!not!be!the!only!one!expected!

to!change)!

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WAVE!Ottawa!would!like!to!thank!the!following!for!making!this!possible:!

Sheila!Bell,!SpeechBLanguage!Pathologist!!and!Rogers!Cable!22!

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Dovercourt!Recreation!Association!