spring 2012 volume 6, issue 2€¦ · county united way (ocuw), to provide developmental screening...

Spring 2012 Volume 6, Issue 2

Cover artwork created by Jacob Tan Copyright © 2011 by Vera Bernard-Opitz

2 Autism News of Orange County – RW Spring 2012

C O V E R F E AT U R E

Editorial TeamVera Bernard-Opitz, Ph.D., EditorGinny Mumm, Associate Editor

Editorial BoardNicole Gage, Ph.D. Wendy Goldberg, Ph.D.Gillian Hayes, Ph.D.Leslie Morrison, Ph.D.Janis White, Ed.D.

Executive BoardCarol Clayman Valerie K. deMartino, EsqJoe Donnelly, M.D.Dennis Roberson Janis B. White, Ed.D.

Advisory BoardLOCALValerie K. deMartino, Esq.

Long Beach, CaliforniaWendy Goldberg, Ph.D.

University of California, IrvineBeth Huntley-Fenner

Irvine, CaliforniaHyeKyeung Seung, Ph.D.

Cal State University, FullertonBelinda Karge, Ph.D.

Cal State University, FullertonConnie Kasari, Ph.D.

University of California, Los AngelesJennifer McIlwee Myers

Orange County, CaliforniaEmily Rubin, MS, CCC-SLP

Communication Crossroads, MontereyBryna Siegel, Ph.D.

Dept. of Psychiatry, University of California, San FranciscoMarian Sigman, Ph.D.

University of California, Los AngelesBecky Touchette

Saddleback Valley Unified School District

NATIONAL/INTERNATIONALBarbara Bloomfield, M.A., CCC-SLP

Icon Talk, Goshen, New YorkMarjorie H. Charlop-Christy, Ph.D.

Claremont McKenna College and The Claremont Autism Center

V. Mark Durand, Ph.D.University of South Florida, St. Petersburg

Patricia Howlin, Ph.D.St. Georges’s Hospital London, England

David Leach, Ph.D.Murdoch University, Australia

Gary Mesibov, Ph.D.University of North Carolina, Chapel Hill Division TEACCH

Salwanizah Bte Moh.SaidEarly Intervention, Autism Association, Singapore

Fritz Poustka, M.D.University of Frankfurt, Germany

Diane Twachtman–Cullen, Ph.D., CCC–SLPADDCON Center, Higganum, Connecticut

Pamela Wolfberg, Ph.D.San Francisco State University

We are pleased to feature one of our local artists, Jacob Tan.Read more about Jacob on page 26.

Mission StatementAutism News of Orange County & the Rest of the World

is a collaborative publication for parents and professionalsdedicated to sharing research-based strategies, innovativeeducational approaches, best practices and experiences inthe area of autism.

Submission PolicyThe Autism News of Orange County–RW is available free

of charge. The opinions expressed in the newsletter do notnecessarily represent the official view of the agencies involved.

Contributions from teachers, therapists, researchers andrelatives/children of/with autism are welcome. The editorsselect articles and make necessary changes.

Please submit articles in Microsoft Word using font size12, double spaced, and no more than four pages in length(2600 words). Photos are encouraged and when submittedwith articles the permission to include is assumed.

Please E-mail all correspondence to: Dr. Vera Bernard-Opitz

[email protected] visit our website: www.autismnewsoc.org

C O N T E N T S

EditorialEarly Assessment and Intervention ....................... 3

ResearchEarly Intervention Underlying Characteristics ..... 5

Education/Therapy Strategies to Improve Attention ........................... 9

Environments for Early Intervention ................. 13

Autism Therapy Center Bremerhaven ............... 14

The Issue of Selective Eating ...............................18

Help Me Grow Offers Free Screening .................20

Parent/FamilyA Red Tandem Bike .......................................... 22

Cover Artist: Jacob Tan .....................................24

News/HighlightsSupportors/Sponsorships/Donations ..................25

Events..................................................................26

www.autismnewsoc.org

mailto:[email protected]

Spring 2012 Autism News of Orange County – RW 3

The current issue of the AutismNews focuses on Early Assessmentand Intervention - a topic whichtouches not only families, diagnosti-cians, and interventionists, but alsopolicy makers and service providers.How can we recognize early signs ofautism in infants and young childrenand start intervention as early as pos-sible? Which intervention can helpwhen an infant lacks early commu-nicative and social behaviors, such aslooking at his parents, smiling inresponse to their smiles, sharing his small joys andtroubles in social interactions, or pointing to share hisexperiences? And – if all these normal skills don’tdevelop at the expected time - what exact behaviorshould be targeted? Or to put it in behavioral terms,what behavior is “pivotal to major developmentalprogress and behavioral change?” And which methodis appropriate and effective for this age group?

Since we are starting something very new wemay also need to consider critical questions such asthe following:

• Can assessment ever be done too early? How sta-ble is a diagnosis made at the tender age of threeto six months?

• Are there possible side effects to well-meant

campaigns for early recog-nition of autism, such asworrying new parents byexposing them to the “redflags for autism,” some-times even before theirchild is born? Flyers withheadlines such as “Could itbe autism?” surely leavetheir “worry-traces” notonly in pregnant moms,but often also in grandpar-ents, other relatives and

friends. Most of our colleagues assume that thebenefits of early assessment outweigh the risksof false alarms – and we hope that this is true.

• It has been shown that ABA and structuredteaching have made an enormous difference inthe lives of individuals with autism. Do wehave sufficient comparison studies, however, tojustify early intervention with infants? If so,which method with which behavioral targetshould be used for how many hours a day?

• Two YouTube examples of interventions beforethe age of 24 months have been a highlight ofmy recent workshops in Germany. The videofrom the Early Start Denver program “PattyFeet” shows a child-initiated sophisticated inter-play between an infant and a therapist, while thevideo “Speech Therapy at 22 months” shows atherapist-directed behavioral interaction usingphysical prompts and behavioral contingencies.Both demonstrate interventions that have dif-ferent underlying philosophies but clear positiveeffects. Matching the right method to theprerequisites of young children obviouslyneeds more data and research evidence.

While the current issue of the Autism News can-not answer all the questions involved, it sheds somelight on the above discussion points.

• In the first article Barry Grossman and RuthAspy – authors of the Ziggurat Model - describe

E D I T O R I A L

EditorialBy Vera Bernard-Opitz

Example of the Early Start Denver Model ofautism YouTube: Logan_PattyFeet.mp4

Speech Therapy at 22 monthshttp://www.youtu.be/watch?v=WyQ8a1nqWJk&feature=fvwrel


an assessment tool that is designed for childrenfrom three months through 72 months. It islaudable that the authors do not focus solely ondevelopmental milestones, but include thechild’s strengths as well as parental concerns.

• Rebecca Hernandez presents Help Me Grow,a joint project of UC Irvine Department ofPediatrics and CHOC (Children’s Hospital ofOrange County), which is funded by OrangeCounty United Way (OCUW), to providedevelopmental screening and monitoring tosiblings of children diagnosed with an AutismSpectrum Disorder (ASD) from age 2 monthsto five years.

• Regarding pivotal skills in early intervention,previous research has stressed the crucial roleof attention in young children with autism.Elena Patten and Linda Watson from theUniversity of North Carolina differentiate var-ious types of attention (such as orienting, sus-taining, shifting and joint attention) and sum-marize specific strategies for enhancing atten-tion. An interesting finding is that regardlessof the teaching method (ABA, milieu teach-ing, pivotal response training) or the interven-tionists (therapists, parents, grandparents)children benefitted when interventionsfocused on improving attention.

• Eva Hegewald from the Autism Center inAlfeld, Germany, shares impressions from anintegrated kindergarten program. Photos ofthe center show how orientation and interac-tion for children with autism and other devel-opmental problems can be facilitated througharchitectureal and play equipment design.

• Christine Arens-Wiebel from the AutismCenter in Bremerhaven, Germany, summa-rizes four years of early intervention on thedevelopment of a child with autism. A com-prehensive program emphasizing child train-ing as well as family involvement is presented.

• Catherine Gutshall from the CARD Programpresents strategies for selective eating – aproblem frequently faced by parents of youngchildren with autism. Her intensive interven-

E D I T O R I A L

tions demonstrate that behavioral interventioncan make a big difference in daily challenges.

• Bobbie McIntyre shares her sadness about thelimitations her children affected by autismface, and also the joy of finding new opportu-nities. Her article, “Red Tandem Bike,” can beseen as a symbol for exploring different ideas,being ready for the unusual and celebratingthe unexpected joys along with our children.

• Last, but not least Lee Hong Eng fromSingapore shares her son’s interest in art. SinceI had the opportunity to follow Jacob’s devel-opment from a young, bouncy child into a tal-ented young man, I specially appreciate thestory “I want to become an artist,” ThanksJacob, for your outstanding cover picture!

We thank all our authors for their contributionsand our supporters for their generous support, all ofwhich have made ANOC 17 possible. The next issueof the Autism News will focus on Social SkillsPrograms, but again depends on your donations.

Wishing you all the best for the new year.

Vera Bernard-Opitz, Ph.D.Clin. Psych, BCBA-DEditorWebsite: www.verabernard.orgWebsite: www.verabernard.deE-mail: [email protected]

WE STILL NEED YOUR SUPPORTTo continue our newsletter, we need your support.

Please make a donation to our newsletterso we can continue to spread the word

in our community!

For more information, please visit us at:

www.autismnewsoc.org or [email protected]




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R E S E A R C H

As educators and parents strive to develop mean-ingful educational opportunities for individuals withAutism Spectrum Disorders (ASD) it is important tobegin with a thorough understanding of the child’sneeds. This can be accomplished through the use ofthe Underlying Characteristics Checklist (UCC), acomponent of the Ziggurat Model (Aspy &Grossman, 2011a). The Ziggurat Model provides acomprehensive framework for designing interven-tions for individuals of all ages with ASD. This arti-cle will focus on its use in early intervention. Thepremise of this model is that underlying needs andcharacteristics related to the autism spectrum mustbe addressed. Therefore, the Ziggurat Model isdesigned to utilize a child’s strengths to address trueneeds or underlying deficits that result in social, emo-tional, and behavioral concerns. The ZigguratModel, whose name is derived from its multi-steppedpyramid shape, centers on a hierarchical system, con-sisting of five levels that must be addressed for anintervention plan to be effective (see Figure 1).

Figure 1. The five levels of the Ziggurat Model.

The Underlying Characteristics Checklist – EarlyIntervention (UCC-EI)

The UCC is an informal tool created to identifycharacteristics of ASD for the purpose of interven-tion design. Specifically, it was developed as the firststep in linking an individual’s ASD to interventions.There are three forms of the UCC for use with indi-

viduals across the lifespan (Aspy & Grossman,2011b). The high functioning (UCC-HF) and clas-sic (UCC-CL) versions are designed for individualsfrom six years through adulthood. The newest ver-sion is the UCC-Early Intervention (UCC-EI) isdesigned for individuals from three months through72 months (Aspy, Grossman, & Quill, 2011).

Research shows that early intervention ofASD is critical to improved long-term outcomes(Dawson & Osterling, 1997; Eikeseth, Smith, Jahr,& Eldevik, 2007; Harris & Handleman 2000;Ingersoll, 2011; Lord, 1995; McEachin, Smith, &Lovaas, 1993; Rogers, 1998; and Smith, Groen, &Wynn, 2000). Thus, early identification of symp-toms is essential. Because early intervention makesa critical difference in the progress of individualswith ASD, delay in identification is a matter of greatconcern. Unfortunately, there are few instrumentsavailable to identify ASD in children at 18 monthsor younger. Delays in identification are especiallycommon for higher functioning individuals withASD. Often these individuals do not present withclassic symptoms at a young age and therefore maymiss opportunities for early intervention. If thesechildren receive services at all, it is often not until theend of the elementary school years or later.

The goal of closing the gap between onset ofsymptoms and diagnosis presents many challenges.Nadal and Poss (2007, p. 409) state that “earlydetection of ASD is . . . difficult because symptomsduring infancy may be more difficult to detect ormay present differently from manifestations of thedisorder at later stages (Baranek, 1999).” Becausethere are no medical tests for ASD, identification isbased on observation of behaviors and developmen-tal history. While the use of a system, such as theDiagnostic and Statistical Manual (DSM), has beenshown to aid in accurate identification (Klin, Lang,Cicchetti, & Volkmar, 2000), the characteristics of

Assessment for Early Intervention from Three months through 72 months: The Early Intervention Underlying Characteristics Checklist By Barry G. Grossman & Ruth Aspy


R E S E A R C H

ASD outlined in the DSM are not as sensitive whenapplied to children under the age of three (Volkmar,Chawarska, & Klin, 2005) and some of the criteriaare not applicable for this young population (Stone,Lee, Ashford, Brissie, Hepburn, et al., 1999). Use ofthe UCC-EI provides a way to more appropriatelyserve children at a younger age even when their diag-nostic picture remains unclear.

In most early childhood programs, children areidentified and served based on evaluation of develop-mental delays. Not all disabilities can be detectedthrough examination of milestones alone. In fact,many young children with ASD, especially those whomeet the developmental milestones in communica-tion, are often not identified through this approach.Furthermore, use of milestones alone fails to identifyall concerns that require intervention. For example,significant tantrums, obsessive interests, or sensorydifferences may not be identified through the use ofdevelopmental milestones; however, these concernsshould be recognized and addressed. An approach toserving children who are not obviously failing to meet

specific developmental milestones or those whoseatypicalities are not included in the traditional devel-opmental curriculum is needed.

The UCC-EI was developed to fill this void bynot only taking into consideration the developmen-tal normative data typically used to determine eligi-bility for early childhood programs, but also atypi-calities and concerns that may be characteristic ofASD. A childhood checklist may inquire about theage at which a child started speaking in phrases,whereas the UCC-EI includes multiple items thatexamine the child’s use of phrases as well as the qual-ity of the utterances (e.g., presence of idiosyncraticlanguage, echolalia, and joint attention deficits). Atypical screening instrument may include the age atwhich the child begins parallel play with peers; how-ever, the UCC-EI also takes into account the objectswith which the child plays, the quality of the inter-action with peers, and the child’s ability to transitionbetween play schemes. Atypicalities in these andother areas, such as hyperlexia, are not delays thatwould be detected through a developmental check-list but are very meaningful.

The UCC is comprised of 104 items in eightareas. The first three represent the autism spectrumtriad, social, restricted patterns of behavior interestsand activities, and communication. Characteristicsoften associated with ASD are addressed in the nextfour areas: sensory differences, cognitive differences,motor differences, and emotional vulnerability. Theeighth underlying area is known medical and otherbiological factors. Designed to be completed by par-ents, teachers, or other service providers, individual-ly or as a team, the UCC-EI items describe thebehaviors associated with ASD.

A Notes column provides a space to describe howa given characteristic is expressed in an individual.Information in this column may include specificexamples, frequency of behavior, commonantecedents or triggers, and so on. While the UCCprovides a snapshot of the autism in an individual,the Notes section helps to bring clarity to this pic-ture. Further, this information aids in communicat-ing with others involved in intervention andbecomes a basis of comparison for follow-up.

Good Idea Corner

Bedtime can be made moreattractive by turning interestsand fascinations into wallpaperand bed-sheets. We appreciate this idea andphoto from Arno and Sabine Klemm.


R E S E A R C H

The UCC-EI contains a column entitled, Age ofConcern. Because some behaviors, such as babblingor mouthing objects, are typical at certain phases ofdevelopment and of significant concern duringother periods of development, it is important totake this into consideration when completing thechecklist. This column describes the age at whichthe specific behavior is of concern. In addition, tounderstanding the manifestation of an individualchild’s ASD, it is also essential to have an adequatedescription of the young child’s strengths andemerging skills. The UCC-EI incorporates two waysto document these-- the Individual Strengths andSkill Inventory and the Description of Masteredor Developing Skills column. With this knowl-edge, program planning can include interventionsthat address needs through strengths.

Figure 2. Sample of UCC-EIitem with research

Careful to provide empiricallysound information regardingautism and typical developmentalmilestones, the UCC-EI includesthe sources from which all develop-ment milestones were derived. Asample of one UCC-item in theSocial Domain that addressesresponsiveness to others appears inFigure 2.

Case Study

A brief case study of a toddlerillustrates the use of the UCC-EI.

When Leigh Ann was 22 months old, her parentsnoticed that she was not interacting with other chil-dren at daycare and that she was often distressed byloud sounds. Leigh Ann’s parents were worried thather language appeared to be limited compared tothat of other children in her class. Also, she did notseem to enjoy games like peek-a-boo and spent mostof her time playing alone. Leigh Ann is now 4 yearsold and attends a public school early childhood pro-gram. The school evaluation team identified herwith ASD and speech impairment. Leigh Ann’s eval-uation report describes many characteristics relatedto ASD. She communicates using 4- to 5-word sen-tences. She does not seem interested in others andoften withdraws from group activities. When sheplays near peers, she often takes their toys from themand does not seem to notice when they cry as a

result. Eye contact is fleet-ing. At home, Leigh Annoften prefers solitary activi-ties. When she does initiatesocial interactions withadults and peers, it is usuallyin order to have her needsmet (e.g., requesting pre-ferred objects or food), topoint out sparkly objects, orto get others to join her asshe recites the names of the

Table 1. Excerpts from Leigh Ann’s UCC-EI


R E S E A R C H

Disney princesses.

Leigh Ann requires prompt-ing to engage in play andextended social interactions thatare not related to her interests.Leigh Ann’s parents say that shehas some repetitive and narrowinterests. For example, shewatches the same Disneyprincess movies for hours andoften recites lines or acts outscenes from the films. She occa-sionally asks her parents or sis-ters to join her in reciting lines;however, she becomes upset if they do not recitethem exactly as they are in the movie. Leigh Ann hasa princess backpack that she insists on carrying withher when she leaves home. It is filled with princessdolls, dress-up clothing, and activity books. Sheoften lines up her princess figures according to cloth-ing color and height. Leigh Ann’s multidisciplinaryteam, including her parents and teachers, met todevelop a new program for her.

The team began by completing the UnderlyingCharacteristics Checklist – Early Intervention(UCC-EI) and Individual Strengths and SkillsInventory (see Table 1). Once priorities were estab-lished using steps outlined in the Ziggurat Model,Leigh Ann’s team developed meaningful interven-tions using the Ziggurat Worksheet. A summary ofUCC items and interventions is provided in Table 2.

They began by reviewing interventions currentlyin place – those that addressed selected UCC items(priorities) were included on the worksheet. Otherstrategies were considered to be off target and werenot included in Leigh Ann’s comprehensive plan.Next, they created new interventions – making surethat each UCC item was well addressed and that suf-ficient strategies were developed for each level.

Summary

Information gathered through use of the UCC-EIhelps parents and professionals to plan an individual-ized comprehensive program using the ZigguratModel, perhaps even before the child is diagnosed.

Further, assessment of underlying characteristics pro-vides insight into which skills should be taught andhow to design instruction in order to facilitate learningand bring about meaningful and long-lasting change.The UCC-EI offers an effective way to begin programplanning by providing a comprehensive perspective.

Note: The Underlying Characteristics Checklist– Early Intervention (p.20), by R. Aspy and B.Grossman with K.A. Quill, 2011, Shawnee Mission,KS: Autism Asperger Publishing Company.Copyright 2011 by AAPC. Reprinted with permis-sion. www.aapcpublishing.net

Dr. Grossman and Dr. Aspy are LicensedPsychologists who have founded the The ZigguratGroup. For further information, please see www.tex-asautism.com

For further information, please contact:

Barry G. Grossman, Ph.D.E-mail: [email protected]

Ruth Aspy, Ph.D.E-mail: [email protected]

For the references, please contact the authors.

Table 2. Excerpts from Leigh Ann’s comprehensiveintervention plan

mailto:www.texasautism.com


www.texasautism.com

www.texasautism.com

www.aapcpublishing.net


R E S E A R C H

What clinician hasn’t been excited to implementa new treatment plan only to find that the plancould not be executed because the child’s attentionwas never adequately engaged? Indeed, this can be acommon dilemma when working with children withAutism Spectrum Disorders (ASDs). However, onceattention is adequately captured, learning can occurperhaps even to an even greater extent than is some-times expected.

Although research describing features of atten-tion in children with autism is extensive, researchdescribing interventions thataddress attention are not asabundant. Attention can beviewed in many different ways.One commonly accepted way todescribe attention is in terms oforienting attention (the initialcapture of attention that usuallyresults in looking at a stimulus),sustaining attention (the ability to maintain focus ofattention on a particular stimulus which allows fur-ther processing of information), and shifting atten-tion (the ability to disengage from one stimulus andreorient attention to another stimulus).

Orienting attention isimpaired in children and adultswith autism (Renner, Klinger, &

Klinger, 2006; Townsend, Harris,& Courchesne, 1996). In fact,

research has demonstrated that children as young aseight to 10 months old fail to orient to stimuli thatcaptures the attention of typically developing chil-dren (Werner, Dawson, Osterling, & Dinno, 2000).Difficulty capturing attention directly impactsinterventions because if we are unable to drawattention toward stimuli, the child cannot partic-ipate in any learning we target.

Sustaining attention is a relative strength inthat once attention is adequately captured, individu-als with autism can maintain attention to a stimuluswhile ignoring competing stimuli (Landry &Bryson, 2004; Zwaigenbaum, et al., 2005). It isimportant to note that this characteristic does notnecessarily mean that children with autism havesuperior processing in terms of what is typicallyexpected. Consider the propensity for children withautism to focus on parts rather than on the wholeobject. In children with this propensity, superiorprocessing of details may occur but gestalt informa-tion may be lost. However, unique characteristics ofsustained attention might still be harnessed to creat-ed positive learning outcomes.

Shifting attention is a two-step process: 1)disengaging from one stimulus; and 2) shifting to

another stimulus. Disengaging atten-tion is impaired in autism (Swettenhamet al., 1998; Zwaigenbaum et al., 2005)and this supports findings discussed inthe previous paragraph describing supe-rior sustained attention, which canextend so far that competing stimuli failto result in disengagement from the cur-rent locus of attention.

A discussion of attention in childrenwith autism is not complete withoutdescribing joint attention; shared atten-tion between two individuals and anobject or another individual. Attentionorienting, sustaining and shifting atten-tion are all included in joint attention.

Strategies to Improve Attention in Children with ASDsBy Elena Patten & Linda R. Watson

Intuitively, clinicians mayaddress this by hidingitems that are not part ofthe therapeutic activity orremoving items that are nolonger needed and quicklypresenting new items inthe child’s visual field.


R E S E A R C H

Joint attention includes both responding to jointattention (i.e., someone else directing your attentionto a third entity) and initiating joint attention (i.e.,directing someone else’s attention to a third entity).

Joint attention has been fairly well studied intypically developing children and children withASDs. Studies demonstrate ties between joint atten-tion skills and later-developing language skills in

both groups with consistent deficits found in chil-dren with ASDs (e.g., Dawson et al., 2004; Mundy& Newell, 2007; Sigman & Ruskin, 1999).

Treatment Targeting Attention in Children with Autism

Limited empirical evidence exists regardingintervention strategies to address attention whenworking with children with autism. The National

Standards Project (NSP) report (National AutismCenter, 2009) produced a structured systematicanalysis of the level of scientific evidence pertainingto treatment of individuals with autism. The projectdelineated ten treatment targets and graded the qual-ity of evidence. Although “attention” was not speci-fied as a treatment target, attention-gaining strategieswere implicit in many of the treatment categories.

For purposes of this article, original research wasidentified that specifically used attention as an out-come variable (for a more detailed description ofsearch methods and findings, see Patten & Watson2011). Study goals could be categorized by thera-peutic interventions (those that sought to habilitateattention in the long term) and accommodations(those that drew attention in the moment quicklyand contingently).

Therapeutic Interventions. Twelve studies wereidentified that targeted some form of attention with-in a larger treatment protocol that was either natural-istic or applied behavioral in nature (e.g., Bernard-Opitz et al., 2004; for more information on eachstudy see Patten & Watson 2011). All of these stud-ies demonstrated that attention improved in childrenwith autism. Joint attention was the outcome vari-

Strategies Used in Therapeutic Interventions

Strategy Studies

Child-directed play. The child selected the activity, materials ortopic and the adult inserted an intervention within that context.Using child-directed play may be beneficial because children withautism demonstrate difficulty with disengaging and shifting attention,processes which are required more by adult-directed play compared toself-directed play.

Gulsrud, Kasari, Freeman, &Paparella, 2007; Ingersol &Schreibman, 2006; Kasari,Freeman, & Paparella, 2006; Saltet al., 2002; Shertz & Odom2006; Vismara & Lyons, 2007;Whalen & Schreibman, 2003;Yoder & Stone, 2006

Reinforcement. Reinforcement included natural reinforcement,such as getting access to a toy after directing another’s attention tothat toy, or artificial reinforcement, possibly receiving a small fooditem for directing another’s attention to a toy. Other means ofreinforcing included allowing the child continued access to pre-ferred toys or providing verbal praise.

Gulsrud et al., 2007; Ingersol &Schreibman, 2006; Kasari et al.,2006; Vismara & Lyons, 2007;Whalen & Schreibman 2003


R E S E A R C H

able for ten studies while the two remaining studiestargeted “attending to parents and therapists” and“off-task behavior.” Specific strategies were oftenmentioned within designs but unique contributionsof strategies were difficult to ascertain due to theglobal nature of the intervention. However, severalstrategies emerged across multiple studies that werelinked to improvements in attention.

Other strategies targeting attention were alsoused but with less frequency. Those included: 1)environmental manipulation, such as placing adesired item in a tightly closed jar so that the childwould have to request assistance to get the item

(Kasari et al., 2006; McDuffie et al., 2006; Yoder &Stone, 2006); and 2) linguistic mapping, in whichthe adult talks about what the child is doing(Ingersoll & Schreibman, 2006; Kasari et al., 2006;Salt et al., 2002).

Accommodations. There are often times thatgaining attention immediately for the sake of teach-ing other specific skills is necessary. We can viewsuch strategies as “accommodations” and they arecommonplace in educational settings. For example,an accommodation for a child requiring assistance inguiding attention is to provide preferential seating toincrease the salience of the lesson being taught. Five

Imitation. Adults imitated the child’s behavior during an interven-tion, such as imitating facial expressions, actions on objects andmotor actions/gestures. This is a simple strategy and somewhat simi-lar to child-directed play in that the child is leading the interaction. Theadult imitates the child, typically with the idea that this will result in aturn-taking activity in which the child eventually may imitate the adult.

Gulsrud et al., 2007; Ingersol &Schreibman, 2006; Kasari et al.,2006; Salt et al., 2002; Shertz &Odom 2006; Yoder & Stone, 2006

Prompting. Cuing or prompting included visual, tactile and audi-tory cues. Prompting is part of most therapeutic interventions and is log-ically linked to attention. Prompting can be accomplished in many waysincluding more direct prompts such as physical touch as well as more subtleprompts such as gestures or single words to support attention. Cuing hierar-chies are often employed beginning with the most indirect prompts and mov-ing to more and more obvious prompts until the target behavior is attained.From that point, the goal is to fade prompts to work toward independence.

Gulsrud et al., 2007; Kasari et al.,2006; Salt et al., 2002; Shertz &Odom 2006; Whalen &Schreibman 2003; Zercher, Hunt,Schuler & Webster, 2001

Strategies Used to Accommodate Interventions

Strategy Study

A combination of a verbal cue (the word “look”) plus a gesture(pointing) improved looking to objects upon request.

Leekam et al. (1998)

Child-centered play and imitation improved joint attention (see “ther-apeutic interventions” above). In this experimental design, adults imi-tated or expanded the child’s play using an identical set of toys.

Lewy & Dawson (1992)

Using labels when referring to novel objects drew attention to theobjects compared to using child-directed speech without labeling.

McDuffie et al. (2006)

Token reinforcement increased attention but returned to baselinewhen removed. Tokens were stickers used to earn a break.

Tarbox et al. (2006)

Using the child’s perseverative interests as targets improved joint attention. Vismara & Lyons (2007)


R E S E A R C H

studies were identified that specifically assessedstrategies used to accommodate attention. Strategiesechoed those mentioned above in the “therapeuticintervention” section but because each accommoda-tion was investigated as a single component, conclu-

1) Toys should be chosen that are of interest to the child in order to encourage attention natu-rally. Parents and teachers are an ideal resource for discovering these. Clinicians shouldbeware of triggering a perseverative behavior, which may cause the child to become over-focused on an object to the exclusion of intervention goals.

2) Allow the child to select from a small offering of objects and follow up with communicationand interventions around the child’s locus of attention.

3) Imitate the child’s actions on objects in an attempt to elicit reciprocal play. If the child isresistant to releasing objects, try having an identical set of objects to mirror the child andwork toward reciprocal imitation.

4) Use specific labels when talking about the objects in the child’s locus of attention.

5) Use multimodal prompts, such as combining visual and verbal cues or tactile and visual cues.

6) Provide natural or artificial reinforcements for attention. Remember that token reinforce-ment might increase attention in the short term and allow a window of attention duringwhich learning may improve, but attention may wane when token reinforcement is removed.

In sum, the following empirically-based strategies can be feasibly employed inmost broader treatment protocols:

sions regarding efficacy can be drawn with moreconfidence. Specific accommodations that resultedin improvements in attention are in the chart below.Summary and Clinical Implications

Although research identifying and testing thera-peutic strategies to specifically address features ofattention in children with autism is not exhaustive,some empirically validated studies do exist. Theavailable evidence suggests that, regardless of thelarger treatment design being used (e.g., ABA,mileu, pivotal response), children with autism bene-fit from intervention directed at improving atten-tion. Also, children appear to benefit regardless ofwhether the intervention is provided by parents,clinicians or peers.

Using wisdom gained from their experiencewhile honoring family values and employing empir-ically-based strategies can help clinicians develop an

evidence-based practice for the treatment of childrenwith ASDs.

This article has been adapted from Patten andWatson, 2011, published in the American Journal ofSpeech-Language Pathology, an American Speech-

Language-Hearing Association publication. Pleasefollow the link for access to full text:

http://ajslp.asha.org/cgi/content/short/20/1/60.

For further information please contact:

Elena Patten, Ph.D., CCC-SLPAssistant ProfessorDepartment of Communication Sciences and DisordersSchool of Health and Human PerformanceUniversity of North Carolina, GreensboroE-mail: [email protected]

Linda Watson, Ed.D.ProfessorDepartment of Allied Health Sciences, School of MedicineUniversity of North Carolina

For the references, please contact the authors.


http://ajslp.asha.org/cgi/content/short/20/1/60.

E D U C AT I O N / T H E R A P Y

The Autism Center in Alfeld, Germany is a facil-ity of the Lebenshilfe, which offers consultation andtherapy for children with Autism SpectrumDisorders (ASD) and their families, childhood edu-cators, and teachers. The center is located in Alfeld,Germany, which a small community with 20,000residents located near Hannover, Germany. Thearchitecture of the building is adapted to the needsof young individuals with autism or other specialneeds. The center has three full-time autism consul-tants, who engage in direct therapy with affected

children, but who also train others involved andorganize related workshops. While the close proxim-ity to an integrated kindergarten makes inclusionoptions easy, specialized treatment rooms allow fordistraction-free interventions.


Eva HegewaldWebsite: [email protected]

Environments for Early Intervention Impressions from the Autism Center in Alfeld, GermanyBy Eva Hegewald

Open spaces andretreat options, such

as the beehive-swing,offer opportunitiesfor relaxation and

cooperative play

Wall decorations can be usedfor play and interaction. As a

simple example, one childdrops a marble into the holeand another other catches it.

Not all children withASD enjoy the brightsunshine on the left, soenvironments can beadapted for differentchildren.

Color-coded buildings are easy foryoung children with autism to find

Up to eight children can swingtogether in the beehive.


[email protected]



Intensive Early Intervention in the Autism Therapy Center BremerhavenBy By Christiane Arens-Wiebel

Specialists and parents agree that there is anurgent need for early intervention for children withASD. Early intervention services have been devel-oped to a greater extent in the U.S. and England, butare also present in Spain, Canada, Norway, Polandand Germany. Since Ivar Lovaas first began usingbehavioral intervention, the positive effects of EarlyIntervention Programs have been scientifically docu-mented (Lovaas et al, 1981, 2003; Eldevik et al,2006). Typically six to eight hours of one-on-onebehavioral therapy are conducted per day, providingan average minimum of 30 hours of intensive treat-ment per week.

Children have a better chance of reducing autis-tic behavior problems during the first three years ofrapid brain development, since their brain is moreflexible. Progress tends to depend on the age of thechild and the intensity of treatment. Children startto learn in an effective manner when their self-stim-ulations are replaced by functional activities.

Intensive Early Intervention in BremenSince 1984, early intervention has been estab-

lished in Bremen as a primary service (Cordes,1985). In comparison to the more common “onetherapy hour per week” schedule, more than 40 chil-dren below the age of four received between four andtwelve sessions per week. In the beginning, the par-

ents and staff of the local preschools were concernedabout possible stressors through intensive treatment,but soon found the intensive interventions werehelpful for the children.

Since 2000, all children with ASD between theages of one and three years receive two-hour interven-tions at least three times per week with a therapistfrom the Autism Therapy Center Bremen orBremerhaven. If possible, trained psychology or spe-cial education students from the University of Bremenspend an additional two to six hours with the childrenas part of their practicum. The students have beenintroduced to autism, behavior therapy, sensory-motor integration and Affolter intervention. Parentsand all other co-therapists are regularly supervised.

,

A team of experienced psychologists and socialeducators assesses the child before the age of four yearsusing the M-CHAT (Modified CHecklist for Autismin Toddlers) as well as ADOS-R (Autism DiagnosticObservation Schedule Revised). After diagnosis, thechild is admitted to Early Intervention at the AutismTherapy Center Bremerhaven, where an increasingnumber of two-year old children are treated.

Program for Early Intervention The intervention aims at structuring the day of

young children in such a way that constructive activ-ities and play are facilitated. Depending on individ-ual cases, the program aims at 15 to 30 therapy hoursper week. Everyday activities are used to enhancefine-motor, communicative and social skills. Duringthe therapy time the child works in a one-to-one sit-

M-CHAT for Richard, at two years two months02/07

• No pretend play• No proto-declarative pointing• No response to pointing • No peek-a-boo game • No functional play• Little eye-contact



uation with a therapist, a co-therapist or a parent.Intervention at the table usually lasts 15 to 30 min-utes with sensory-motor or gross-motor breaks inbetween. Usually up to three hours of interventionare possible before a longer break is needed.Children also have the opportunity to get involvedin “regular” activities, such as walks with their par-ents, playground or swimming activities.

Before the beginning of therapy intensive obser-vations and testing are conducted. This helps to getan overview of the developmental age, skill profilewith its strengths and deficits as well as behaviorproblems. Based on this and parent information acomprehensive therapy plan is developed. The firsttherapy sessions focus on communicative events,which are highly motivating. Behavioral interven-tion methods are systematically introduced with thefollowing long term aims:

• Imitation• Verbal and non-verbal communication • Cognitive skills/attention/concentration • Play and social behavior • Perception • Finemotor/Eye-hand coordination• Self-help The first therapy targets tend to be eye contact

and simple imitations, since attention to social cuesand imitation are important prerequisites for thedevelopment of communication, social and playskills. Training of gross motor imitation is supple-

mented by tasks for the development of fine-motor,oral-motor and sound imitation as well as the devel-opment of speech.

Children who fail to respond to the above pro-grams are exposed to object-communication,PECS (Picture Exchange Communicative System)or hand-signs. Often a combination of variouscommunication systems has been helpful. Somechildren are able to use signs to communicate basicneeds (such as eating, drinking and playing), whilerequesting specific food or drink items is facilitatedthrough photos or symbols of food (e.g. banana,cookie), drinks (milk, water) or toys (spinner, mar-bles). Often children start to talk once they areexposed to a non-verbal communication system.

Besides the development of expressive commu-nication, children also are trained in receptive skills.Simple instructions, such as “come here,” “sitdown,” “get the ball,” “wait for Mom” or “go to thekitchen” are targeted, just as well as understanding ofeveryday objects and their features. Children alsopractice comprehension of body parts on themselves,

Observation report of Richard on Languageand Communication, June 2007

Richard communicates his requests through cry-ing or pulling his interaction partner. His vocaliza-tions vary: he rarely speaks a meaningful word, andif he does, he only says it once. Rare utterances are:“oh,” “there,” “cookie,” “thanks,” “tita” (ticking ofclock), “hya, hya” (fire engine). He does not imitatesounds nor words. He sometimes hums – even correcttunes of children’s songs – especially when relaxed. Heunderstands simple instructions, such as: “Give,” “sitdown,” and “pick it up.”

He does not understand receptive labels, such aseveryday objects, animals or bodyparts.

Example for therapy targets inCommunication in July 2007:

• “Want” with sign • Sound imitation • Receptive objects, persons and body-parts



the therapist, a photo or an animal. All training aimsat generalization of learned skills, so that a childknows, that any nose is labeled “nose” and that evenshort legs of a dog are still called “legs.”

Cognitive skills, attention and concentrationare improved through a variety of educational toys,such as puzzles, pegboards, or sorting tasks. Childrenlearn to match and sort objects, pictures, colors,shapes or sizes. In recent years TEACCH methods

and materials have been used, such as shoebox orfolder tasks.

Social interaction and play with children aswell as adults are other important therapy targets.Many children with autism often remain at a basiclevel of manipulative or combination play,meaning that they knock objects on the table, wavethem in front of their eyes, throw them, insert,stack or line them up. Often they require intensive

training programs to engage in functional or pre-tend play. They may learn to comb the doll’s hair,or pretend that the doll feeds itself; they may alsolearn different sequences of car or animal play.Through massed drills children in our early inter-vention have learned to engage in spontaneous pre-tend and role-play, such as setting the table for thedolls, pretending to pour juice and to feed the doll.Functional reinforcers, such as feeling the car on

one’s hands, hearing a car siren or a frictionmotor are often more useful than artificial con-sequences, such as gummy bears.

Parent and social environment Parents, families and the social environment

are highly involved in the above efforts. Parentstend to be receptive about new teaching ideas,training and supervision. Involving parents inearly intervention efforts can prevent that behav-ior problems become fixated and that parentsgive up because their child is difficult.

Important components of parent and socialenvironment are

• Basic parent consultation and supervision • Regular parent training • Improvement of parent-child interaction • Team meetings of parents and therapists • Psychological support to cope with

the disability • Involvement of siblings and grandparents

Parents are introduced to the theory andpractice of autism and interventions (e.g. behav-ior therapy, sensory-motor therapy, communica-tion training). To make support through other

parents possible, meetings are arranged as groupmeetings. Weekly training sessions with children areconducted so that theoretical knowledge is translat-ed into functional training tasks with their ownchild.

Team meetings are held to exchange informationand ideas and to discuss problems and methods.Besides supporting the parents, siblings and grand-parents are involved in discussions. They are also



If I could do nothing but feel,I would want to feel everything:The wind in my hair, the rain on my face,the grass under my feet.

If I could do nothing but hear,I would want to hear everything:The voices of animals and people,The words and explanations,The music of the world.

If I could do nothing but see,I would want to see everything:The sun, the moon and the stars and evenThe inside of a car wash.

If I had problems thinking,I would hope for some structure:Concepts that could organize my perceptions,Situations I could understand.

If my hands could not help me,I would rely on someone else’s hands:Hands that would help me to act,And would help me to help myself.

If I could not make my needs known,I would hope for someone to understand:Someone to read my thoughtsOr someone to understand my handsigns.

If I could only live,Would I be able to live?What would normalization be?

Normalization…. A Different PerspectiveBy Vera Bernard-Opitz

invited to partici-pate in therapy ses-sions. Since 2002 a sibling supportgroup meets regu-larly and discussesproblems and high-lights of living witha brother or sisterwith a disability.

Results of theEarly InterventionProgram

Most of thechildren involvedin our Early

Intervention Program have made good progress.About 80% have developed verbal communication;the remaining have developed handsigns or PECSwith some being proficient with an electronic talker.Cognitive functioning has also improved. Some fewchildren have even developed to the level of “highfunctioning autism” and attend regular schools. Acomment by a regular school teacher: “I have noticedthat Fabian has been in intensive early intervention.He cooperates well, understands instructions and ishighly motivated in class.”


Christiane Arens-Wiebel, Dipl. Social-Pedagogue Autism Therapy Center, BremerhavenE-mail: [email protected]

Developmental level of Richard after fouryears of intensive treatment

• Talks in complete sentences • Asks and answers questions • Completes tasks independently • Has started to write and read • Is still obsessed with certain rituals, such as

taking out and collecting light bulbs.

At the age of four years Richard col-lected more than 100 buttons andsewed them on a piece of cloth.




Eating is a behavior that we often take for grant-ed. It seems so intuitive – we get hungry or some-thing tastes good, so we eat! Unfortunately, enjoy-ing a healthy variety of foods in our diet is notalways so easy for children. It has been estimatedthat up to 25% of all children display some type offeeding problem. Among children with develop-mental disabilities, that estimate jumps to over 75%of the population. Feeding disorders are incrediblycommon and can be a huge stressor in the lives ofthe child and his or her family. Unfortunately effec-tive treatment options are not as wide-spread as theproblem, but they do exist.

Traditionally, the term feeding disorders refers towhen a child does not consume enough food or liq-uid to grow adequately, when a child becomesextremely selective in the food he or she will eatbased on a specific variable (such as color, texture,temperature, or type), and/or when inappropriatebehavior such as tantrums occur during mealtime.Other oral motor issues may also be present, such asthe inability to properly manipulate food within themouth or close the lips around a cup or spoon. Allof these issues can be seen in children with AutismSpectrum Disorders (ASD). Additionally, possiblydue to hallmark symptoms of autism, children withASD may show inflexibility around the eating loca-tion, utensils used, brand of food eaten, or even howa food is prepared.

The clear cause(s) of feeding problems isunknown at this time. It is currently thought thatthe cause(s) may be complex and interrelated. Forsome children, biological (or organic) factors areknown. These can include food intolerances, reflux,gastrointestinal issues, and malformation of the oralcavity and teeth. Environmental (or non-organic)factors such as behavioral learning, caregiverresponses, and familial eating patterns can also affecta child’s feeding. Knowing the etiology of a problemis always helpful in the treatment, however it is not

absolutely neces-sary before begin-ning an interven-tion.

Within feed-ing disorders, avicious cycle canoccur and per-petuate. Achild’s refusal toeat may hinder development and practice of properoral motor skills. This can in turn lead to inade-quate nutrition, and, in extreme cases, failure tothrive. Malnourished children might then lack theenergy needed to become capable eaters.

It is hard to overestimate the impact one child’sissues with food can have on the entire family as theytry to ensure that the child is getting enough nutri-tion. How many different meals per day is theparent cooking for a child? How far away doesthe family have to shop to find that one “perfect”brand of food that the child will eat? Is the fam-ily able to eat together? Can the child eat out inthe community without huge preparation? Weoften find that many hours of each day are devotedto the specific eating patterns of the child. By imple-menting a therapeutic program which produces ahealthy feeding pattern that is similar to that of thefamily, a great deal of stress can be removed from thelife of the family.

When looking for advice on treatment, parentsturn to doctors, therapists, friends, and family. Lotsof differing advice is given! Luckily the literature onfeeding disorders is growing. To date, treatmentswith the most peer-reviewed scientific support arebased upon behavioral principles – also known asapplied behavior analysis (ABA). Although familiesmay know that ABA is an effective approach toaddress the deficits and excesses seen in autism, fam-ilies may not know that ABA can be applied to feed-

The Issue of Selective Eating Among Children With AutismSpectrum DisordersBy Katharine Gutshall



ing issues as well! Although not all ABA providershave the background and training in feeding skills,more such highly trained providers are becomingavailable. Be sure to inquire as to what training andbackground your child’s therapists have had in thefield of feeding specifically.

Behavioral intervention has been shown to suc-cessfully increase food consumption for childrenwith and without developmental disabilities.Additionally, ABA has been shown to increase thevariety of foods a child will eat, to increase self-feeding and the abilityto chew food, and to decrease tantrumbehavior during meals.When working in con-junction with team mem-bers from other disci-plines, some childrenwith feeding tubes havebeen able to gain and maintain adequateweight to allow forremoval of their feedingtubes.

For the majority ofchildren, intensive, inter-disciplinary approachesthat use behavior-basedtreatments are successfulboth at discharge andduring follow-up-studies.However, it has now beenshown that less intensiveintervention (two to 4 hours per week of therapyrather than four to 5 hours per day) can producemeaningful results as well. Given the long-termbenefits of proper treatment and the long-termissues associated with not addressing the issue, it isclear that families need to know that assistance isavailable for their children’s eating problems.Parents need not just “wait for the child to outgrowit.” Feeding disorders can be successfully overcome!

Case Study: Meet Elijah

Age at start of services: two years, 11 months

Diagnosis: Autism Spectrum Disorder

Known food allergies/intolerances: None

Caregivers’ primary concerns: Food selectivity by type, brand

Elijah was a child who showed significant foodselectivity by food type. His diet was significantlymore restricted than is average for a child of his age.He would eat only six foods in addition to three

forms of “junk food.” Elijahwould tantrum and gag duringmealtimes when presented withnon-preferred foods. Elijah alsoshowed inflexibility in his eatingpatterns as he would only eat cer-tain brands of foods, insisted thatfood be presented in a specificmanner (i.e., each bite of yogurtmust have a topping sprinkled onit), insisted on specific utensilsand bottle, and consumed foodsin certain locations (i.e., grapeswhile in the cart grocery shop-ping). Additionally, althoughElijah had adequate fine motorskills, he preferred for his motherto feed him.

Services were initiated forElijah an average of three hoursper week at the clinic and hishome. With approximately 70hours of therapy, Elijah now con-

sumes over 37 new foods while feeding himself.Elijah finishes age-appropriate portions of foods whilesitting independently at the table with his family.


Katharine GutshallCenter for Autism and Related Disorders, Specialized Outpatient ServicesE-mail: [email protected]




Help Me Grow Offers Free Developmental Screeningfor Siblings of Children with AutismBy Rebecca Hernandez, MSEd

Help Me Grow Orange County connects chil-dren from birth through age five and their familieswith developmental services to enhance their devel-opment, behavior and learning. By calling the tollfree number 1.866.GROW.025, parents and allproviders have a single point of access to resourcesfor all young children living in Orange County. Weare a joint project of UC Irvine Department ofPediatrics and CHOC Children’s, funded by theChildren and Families Commission of OrangeCounty since 2005.

Our mission is to connect young children andtheir families to existing resources that enhancedevelopment and behavior. Our vision is that allchildren entering school will be healthy and ready tolearn. Help Me Grow strives to assist not only those

who would qualify for early intervention and specialeducation services, but also those who would not.Specifically, we attempt to reach those children withmilder concerns whose developmental trajectory canbe improved. To assist in this goal, we offer develop-mental screening to target populations in OrangeCounty to identify children at risk for delays andconnect them to appropriate resources.

Research conducted by Glascoe & Macias indi-cates that only 30% of children with developmentalor behavioral problems have been identified andreferred for services before entering kindergarten.The Center for Disease Control and Prevention esti-mates that up to 17% of children have developmen-tal delays and/or disabilities. Given these percent-ages, it is astounding that in Orange County, accord-ing to 2006 Regional Center of Orange Countydata, only 1.6% of children from birth through agefour are receiving early intervention or early child-hood services. Nationally, only 5.9% of preschoolchildren are receiving special education services.

Currently, Help Me Grow has funding fromOrange County United Way (OCUW) to providedevelopmental screening and monitoring to a specifictarget population: siblings of children diagnosed withan Autism Spectrum Disorder (ASD) from age twomonths to five years. These siblings are at risk for ASDand up to 30% may have delays in language, motorand cognition between fourteen months and four anda half years (The Hebrew University of Jerusalem,2006). It is clear that easily accessible developmentalscreening is beneficial for early identification and link-age to further evaluation and treatment.

Help Me Grow uses the Ages and StagesQuestionnaire-3 (ASQ-3), an evidence-based screen-ing tool that accurately identifies children at risk fordevelopmental delay. This tool measures five areas ofdevelopment: communication, gross motor, finemotor, problem solving, and personal-social.

www.pacificchild.com



The initial OCUW funding for this focusedscreening initiative was received in January, 2011,and since that date 58 children have been enrolled toreceive an ASQ-3 and 30 of these children alsoreceived an ASQ: Social Emotional screening.

Once a child is enrolled, the family will bemailed a packet including an age appropriate ques-tionnaire in the language of their choice, eitherEnglish or Spanish. Parents are asked to completethe ASQ-3 in a timely fashion and mail it back inthe provided business reply envelope. The complet-ed questionnaires are scored, interpreted and resultsprovided. If a child’s results indicate cause for con-cern, our staff with appropriate language skills callsthe child’s parents to review and discuss the results.Parents are offered care coordination to help themaccess services for Early Intervention (EI) or EarlyChildhood Special Education (ECSE), community-based programs or further evaluation. The individ-ualized care coordination continues with the parent’sinvolvement until the child is found eligible for aservice under IDEA and/or is connected to commu-nity-based services. In all cases, screening results andreferral information are sent to the child’s family andprimary care health provider with consent by theparents. Children not referred or found eligible forEI or ECSE will continue to be rescreened using theASQ-3 at six-month intervals through age five toensure identification at the earliest opportunity.

Help Me Grow Orange County continues toseek families who may be interested in participatingin this developmental screening opportunity. Toparticipate the child must:

• have a sibling with an Autism Spectrum Disorder,

• be within age two months to five years, and

• live in Orange County, California

If interested in learning more about this develop-mental screening opportunity for siblings of childrenwith autism, please visit www.helpmegrowoc.org orcall Help Me Grow at 1.866.GROW.025.

We Need Your Supportto continue the Autism News

of Orange County!Please donate through the new Autism News

OC Fund at the School of Medicine of UCI

(Go to: Autism News of Orange County).

https://ua-web.uadv.uci.edu/egiving

For further information please e-mail:[email protected]

FREE SUBSCRIPTIONSto the Autism News of OC

are possible through www.autismnewsoc.org




www.newportlanguage.com

www.helpmegrowoc.org

PA R E N T / FA M I L Y


My husband is from an active,outdoor family. When I first met Tim,he often kept his father company onlong bike rides but soon forsook themto be with me. At the time, I felt I hadrobbed my future father-in-law of hisbest friend. Eventually, Tim and Imarried and had children but our twooldest children were diagnosed withAutism Spectrum Disorder (ASD). Although myhusband resumed riding with his dad, the rides werefew and far between.

Life with autism is often hard to bear, not onlydealing with the disability itself but with the loss ofpotential opportunities for your child. Several yearsago, my sister Kharol invited me to watch herdaughter, Kyrie, perform in a color guard competi-tion. As I watched those teenage girls glide anddance across thefloor with vibrantflags waving andsabers flashing, Istarted to cry. Icouldn’t help butthink that mydaughter Marisa,who is severely autistic, would never be able to takepart in something so thrilling.

Of course, even if she were neuro-typical, shemight have no interest in Color Guard. She mightbecome a rebel instead, dying her strawberry-blondehair black, wearing gothic clothes and garish make-up, not to mention plenty of piercings and probablya hidden tattoo. But that girl, most likely standing atthe edge of the school parking lot, telling her equal-ly rebellious friends about her latest D’s and F’s inwhat class and which teachers she told off today,would be able to make a choice. She would have anopportunity to choose who she became…but Marisadid not have a choice.

Now, my second-oldest child is not as severely

affected by ASD as Marisa. Brendan has lots of abil-ities, to the delight and consternation of all whoknow him. He talks all the time, mostly about hisown interests. We are repeatedly asked if Dr. Jekylland Mr. Hyde live in London or if Squidward iscranky and dislikes Spongebob. But Brendan still hasmany limitations.

When he was younger, Brendan used to walkdown the stairs leading with the same foot, left-left-left, until hereached the bot-tom. Now, Iknow all youngchildren do this,but kids with disabilities frequently take muchlonger to overcome these challenges. I knew heunderstood right and left so I improvised. Whenhe would walk down the steps, I called out like adrill instructor, “left-right-left-right, Brendan!”After a few years, he became successful at it. As welive in a condo, with my voice echoing off thewalls and into the courtyard, I often wondered ifmy neighbors thought I was preparing my son forthe armed services.

That would never be a possibility for him toexcel, but we tried to make sure Brendan was able toparticipate to the best of his ability in most activitieswith his peers. He was fully included during elemen-tary school and he stills attends regular elective class-es, like art and computers, at his middle school.However, we’ve never been able to teach Brendanhow to ride a bike.

A Red Tandem BikeBy Bobbie McIntyre

“I couldn’t help but thinkthat my daughter Marisa,who is severely autistic,would never be able totake part in something

so thrilling.”

“Brendan, my second oldestchild, is not as severely

affected by ASD as Marisa.”



The past few years have gotten relatively easierwith Brendan and Marisa so Tim has started ridingmore regularly with his Dad and his older brotherJohn, who had taken over as his Dad’s biking com-panion. Occasionally their younger brother, Steve,joins them along with his two sons Ryan and Chase.This has become a Saturday morning ritual, bikingdown the coast to Newport Beach to have breakfastat Charlie’s Chili.

Often on a Saturday morning, Brendan, whousually rises early, will be sitting at the computer,perusing YouTube as Tim gets ready to leave forhis weekly ride. I’d listen to them from the bed-room, where I would be desperately trying tocatch up on sleep.

“Dad, where are you going?” Brendan wouldask.

“To ride with Grandpa and Uncle John.” Thefront door would close and I would hear Tim clatter

down the stairswith his bike. For awhile, there wouldbe silence and theneventually I’d hear

YouTube start up again. I’ve often wondered ifBrendan cared about being left out.

Sometimes, I’d care.

Last summer, we lost my mother-in-law to abrief and tragic battle with cancer. The Saturdayrides have become much more important to theMcIntyre men.My husband’syoungest brotherKevin, movedhome from NewYork and general-ly all five men par-ticipate on theride.

One Saturday, after Tim returned from the ride,he received an excited call from Kevin. Kevin said heand John had spotted a used, tandem bike for saleand they had purchased it. Tim rushed out withBrendan in tow.

A few hours later they returned. My husbandfound Brendan a helmet and they headed out thedoor. At the bottom of the stairs, was a fire-engine red, tandem bicycle with a little rustaround the edges…it was beautiful! They left forthe nearest park.

When they returned, I asked Tim, how it went.He said, “Brendan did great!” Especially when hesaw some dogs. “Dad, Dad pedal faster,” he saidBrendan would cry out as they rode. Then my hus-band told me, he’d lift his feet up, to let Brendan doall the pedaling. He’d do fine until his energy ran outand then my husband would start pedaling with himagain. They’ve ridden several times this week andBrendan loves it!

Tomorrow is Saturday. I hope the weather holds.Because at the bottom of our stairs sits opportuni-ty… in the form of a red tandem bike.

Postscript:

My husband, Tim drove down to HuntingtonBeach State Park. He and Brendan rode to Charlie'sChili from there, a round trip of about 6 miles.Brendan had breakfast with the "boys." I hope Brendanwill be able to make the entire ride. Eventually, mygoal is for him to ride independently on his own bikeand for Marisa to become the second rider on the redtandem bike!

For further information please contact:

Bobbie McIntyreE-mail: [email protected]

“Eventually, my goal is forBrendan to ride indepen-dently on his own bike,

and for Marisa to becomethe second rider on the red

tandem bike!”

“I’ve often wondered ifBrendan cared about

being left out.”

www.monarchtt.com




I WANT TO BE AN ARTISTPlay-Doh, toilet paper, boxes and masking

tape: these were my son’s first artist tools. From anearly age Jacob sculpted mostly weapons anddinosaurs out of various supplies. In addition, thethousands of Lego pieces were put together, takenapart and put together again into mythical beings ofhis imagination.

Jacob learned to talk within a ten-week Parent-Teacher Training program at the BICC Singapore

Art has always been Jacob’s means of communi-cation with the world at large. At school, his teach-ers noticed very early on that he is good at sculpting.With growing confidence he showed off his finishedwork to his teachers, who nurtured his interest andtalent and exposed him to other forms of art such asbatik painting and anime.

Today, he draws mainly mythi-cal creatures like “The RoyalKnight” which he selected to beexhibited.

Even though Jacob did not par-ticularly enjoy batik painting, his eyefor interesting color combinationssurfaced through his paintings. Hewas chosen to present one of his gar-ment paintings to the President ofSingapore.

Jacob was first introduced toanime when he was 15 years old. Heand a classmate were selected to joinanother school’s anime club, which had had some ofits work published in Japan. His experience over aperiod of six months sparked a new personal interest,which moved him toward expressing his creativityeither on paper or digitally.

The Internet and computer games were Jacob’sprimary sources of inspiration. As his parents, wehad many discussions about whether or not to allowhim access to the Internet. In the end, we allowedhim access to it, but we carefully explained to him

what is appropriate and what he needs to be carefulwith. Of course, as a growing teenager, we had totake away some of his discoveries. Mostly what heaccessed were YouTube guides on Lego assembly andcharacters from computer games. He also discoveredFacebook and now has over 500 friends, mostly peo-

ple he has met through his art.

Jacob’s interest in art has givenhim the opening conversation pieceto engage with others. Most peopleare amazed at the detail he pro-vides, and encourage him.

His artistic renditions are twodimensional, like the characters hesees on the Internet. Recently, hesees shadows. Unfortunately per-spective is something that he doesnot understand yet.

With his growing interest indrawing, Jacob is now more willingto attend an art class outside school.

He has been accepted into an art enrichment schoolnext year and I am very excited for him, as he fur-thers his journey to realizing his dream of becomingan artist.


Lee Hong EngE-mail: [email protected]

Cover Artist: Jacob Lee

Jacob now has a facebook page with more than 500 friendsmostly from art. He sure enjoys his life!


N E W S / H I G H L I G H T S


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March 19, 2012 – “Adolescence, Sexuality, Employment: How do the pieces fit?” by Peter Gerhardt., Ed.D. RCOC, 4-8 p.m.

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April 25, 2012 – Latest research on Autism by David Amaral, Ph.D. from theMIND Institute, RCOC, 4-8 p.m

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www.forockids.org

Avoids eye contactEvita el contacto visual

Lacks creative “pretend” playCarece el juego creativo

Shows indifferenceDemuestra indiferéncia

Copies words like a parrot (“echolalic”)Repíte las palabras como un loro(“en forma de echo”)

Shows preoccupation with onlyone topicDemuestra preocupación/interésen solo un tema/asunto

Does not like variety: it’s not thespice of lifeNo demuestra interés en variedad

Shows fear of, or fascination withcertain soundsDemuestra miedo de/ó fascinación con ciertos sonidosLaughs or giggles inappropriately

Risa/reír inadecuadamente

Displays special abilities in music,art, memory, or manual dexterity Demuestra capacidades especialesen musica, arte, memoria ordestreza manual

Shows fascination with spinningobjectsDemuestra fascinación con objetosque gíran

Does not play with other childrenNo juega con otros niños

Some Examples of Autistic BehaviorAlgunos ejemplos del comportamiento de personas con autismo

• Difficulty with social interactions.Tienen dificultad para socializar con otras personas.

• Problems with speech. Tienen problemas con su lenguaje.

• Disturbed perception.Tienen una percepción anormal de los sucesos que acontecen a su alrededor.

• Abnormal play.Su forma de jugar es anormal.

• Resistance to change in routine or environment.Se resisten a cambios en sus actividad rutinarias ó a su medio ambiente.

SOME EXAMPLES OF AUTISTIC BEHAVIORALGUNOS EJEMPLOS DEL COMPORTAMIENTO DE PERSONAS CON AUTISMO

Shows one-sided interactionDemuestra interacción que es unilateral

spring 2012 volume 6, issue 2€¦ · county united way (ocuw), to provide developmental screening...

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