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2. Autism Awareness Grab and Go Course

3. Introduction This course will help you to: understand what autism spectrum disorders are Understand communication difficulties for clients with autism Understand available strategies to help your work with clients with autism Use further reading to enhance learning What are autism spectrum disorders? Autism is a lifelong developmental disability and is part of the autism spectrum, which is also referred to as the ‘autism spectrum disorder’ or ‘ASD’ for short. Autism can cause impairment in thinking, feeling, language and the ability to relate to others and the effects are very individual and can be diagnosed in early childhood, although many people are not diagnosed until later in life. Aspergers Syndrome is a milder form of autism. There are over ½ a million people in the UK with an ASD which is around 1 in 100.

4. The Autism Spectrum Autism spectrum disorders Many people with autism do not “look” like they have a disability and are sometimes diagnosed with other conditions or labels first. Autism can affect people of any intellectual ability and each person’s level of need will be different. What we mean by ‘spectrum’ is that individuals we support with autism will share three main areas of difficulty; how autism affects them will be very individual to them. These three areas may also be called the ‘triad of impairments’ and they are; Social communication Social interaction Impairment of imagination and social understanding. By working in a person centred approach we can ensure we are meeting the individual’s needs, whatever they may be.

5. Social Interaction People with ASD can find it hard to understand other’s needs, emotions, feelings as well as showing their own. Some difficulties may include; Building and maintaining relationships with others Hard to know what people think or feel The rules of social behaviour – how close to stand to someone, for example Less social skills

6. Social Communication Individuals with ASD can find it hard to understand verbal and non-verbal language, with body language particularly difficult to read. Some difficulties may include; No spoken language or repeats speech over and over A literal understand of words – people say exactly what they mean or makes factual comments that does not relate to situation Difficulty maintaining eye contact Difficult to read body language and facial expressions Difficult to understand the ‘spirit’ of how things are said – not getting the intended joke or sarcasm

7. Social Imagination Individuals with ASD can find it hard to understand the world we are in and can find things difficult and confusing. Some people with ASD prefer a strict structure and routine so they know what is going to happen every day. Individuals we support can often copy what others do without understanding why and when the things they are copying should be done. Some difficulties may include; Difficulty with what could happen next or predicting what might happen Not able to plan – need support to structure day Difficulty in transferring skills learnt from one experience to another, i.e. copes well with stressful incidents in their home but doesn’t cope when someone outside their home exhibits the same behaviour Does not understand danger – may run into the road in front of a car Fear of planning ahead or change, i.e. will not talk about moving home

8. Relationships Individuals we support who have ASD may have difficulties in building or maintaining relationships. Some of the difficulties we have looked at may make it hard for some people to know what their needs may be. Here is a checklist of what you can may need to think of while you supporting individuals. What extent can the individual tell you about their needs? Does the person understand risk assessments and why we do them? What is the best way to communicate with the individual to find out the information you need? Does the individual you support want someone else to be present when you talk about bigger decisions? Does the individual you support have a short attention span – will this impact on how you interact with them? Are there any words or topics you should be careful of? (Trigger words for example) Does the individual have any dislikes, phobias or fears you need to be aware of? Does the individual have any interests you can use in your communications with them? Are the individuals happy and comfortable – eye contact, body language and space Now you know all this – how long should your communication be with the individuals you support?

9. Other related issues Stress and Anxiety Many individuals with ASD experience stress and anxiety as the world is unpredictable. When the stress and tension increases, the level of communication, interaction and sociability is likely to decrease – think about how you feel and act when you are stressed – what happens? How do you react? Sensory issues There can be some sensory sensitivity for individuals with ASD. This can be sight, sound, smell, touch, balance, body awareness and taste. People can be either; Hyper-sensitive Over sensitive Hypo-sensitive Under sensitive Other issues you may come across; Learning disability Specific learning difficulties ADHD Issues with sleep Issues with food Mental health issues (dual diagnosis) On the next page we will look at the different senses and some information that will help you with the individuals you support

10. Senses and Balance Body Awareness To do with muscles and joints, with some of the differences being; Hypo-space – standing too close to people -avoiding obstructions -bumping into others Hyper-motor skills – buttons, shoe laces -moves whole body to view something Smell Using the chemical receptors in the nose, smell is usually the first sense we rely on. Difference may be; Hypo-fail to notice extreme odours -may lick things Hyper-intense smells and overpowering -toileting issues -dislike of perfumes, shampoos etc Balance Our inner ear tells our body the space it is in and how fast or slow it is going in relation to gravity. Some of the differences are; Hypo-the need for rocking, swinging or spinning Hyper-difficulty with activities such as sport -stopping quickly -car sickness -difficulty when head not upright of feet not on ground Taste Some people’s taste buds are extra sensitive and can result in having a limited diet. Some of the differences being; Hypo – likes very spicy food, can eat anything.Hyper – some foods are too strong, some textures are uncomfortable to eat, i.e. children may only eat ice-cream

11. Senses cont… Sound This tells us about sounds around us and is the most commonly recognised sensory impairment. Differences may be; Hypo-partial hearing -not acknowledge specific sounds -enjoys crowded, noisy places Hyper-noise can be magnified or distorted -difficulty concentrating as cannot cut out other sounds -lower hearing threshold Touch This relates to touch, the type of pressure on the skin, level of pain and temperature. Differences may be; Hypo-holds other tight -high pain threshold -self-harm -enjoys heavy objects on top of them Hyper-touch is painful and will withdraw from touch -does not like anything on hands or feet – will throw off gloves or shoes -does not like brushing or washing of hair -prefers specific clothes or materials Sight Situated in the retina and stimulated by light, our sights helps to define people, colours, objects as well as the space around us. Differences may be; Hypo-loss of features and may seem darker -central vision is blurry, looks out of corner or eye or main object magnified, with edges blurry -less depth perception Hyper-bright lights can jump around -too many sources of images, becomes fragmented -focusing on detail is more pleasant than full picture – i.e. speck on a picture rather than full picture

12. Strategies for better working The first thing to do with any new individual you are supporting is to thoroughly read about them in their personal portfolio, so that you have a better understanding of who they are, what they like, what they dislike and what you can do to best meet their needs. AwarenessCreativePrepareStrategy Be aware of who the person is, what they like and dislike. Be aware of the environment around them – is it causing a reaction to the individual. Be aware of the sensory difficulties – are we doing all we can for this person? Use your creativity to communicate with the person. Don’t be afraid to try something new to connect with the person providing it doesn’t use a trigger. Find positive sensory experiences or strategies for your client. Don’t just put the person in a sensory experience, prepare them. Would they need a small amount of stimulus increased over time to get them ready, for example - preparing for a holiday – do you know if the airplane will be too much for them – how could you prepare them for a longer flight? What are the strategies for working with your client? Plan schedules ahead and use communication strategies to tell your client what is happening in a way that makes sense to them. Involve your client in any strategies.

13. Strategies to help Balance Hypo -encourage activites that use their preference for swinging, spinning and rocking Hyper-use visual cues as a prompt for the finish -break down activities into smaller chunks Body Hypo- coloured tape on floor to show boundaries (ie red tape is the boundary for client’s room) -move furniture so easier to get around Hyper-lace boards -threading activities Smell Hypo-use strong smells to keep away from bad smells Hyper -make environment fragrance free, no perfume, after shaves etc Sight Hypo-increase the use of visual cues Hyper-use sunglasses -block out visual distractions where possible – ie, a computer desk with sides to deter from distractions -use blackout curtains to aid sleep and rest

14. Strategies to help page 2 Sound Hypo-use visual clues Hyper-shut doors and windows -prepare before going to noisy places -walkman, mp3 player to sooth with clients choice of music/sounds Touch Hypo-heavier blankets of bed -sleeping bag instead of quilt Hyper-support activities to be done by the client in their own time – i.e. washing hair at their speed -a hug may be painful not nice! -approach from in front and signal if you need to touch them PECS PECS stands for Picture Exchange Card System. Each card has a picture that represents an item, feeling etc that the individual may want to express. This is exchanged as a form of communication Makaton Is similar to PECS in that it is a communication aid to enhance language, literacy and communication skills and shares a similar wording to BSL (British Sign Language) in the UK

15. Other strategies to help Sensory Rooms Sensory rooms were created in the Netherlands in the 1960s to allow stimulation of various senses. Items you may come across are: Disco lights, mirror balls, touch panels for lights, lava lamps, fibre optics, waterbeds, bubble tubes, bubble machines. These items can be turned on or off using pressure, sound and movement to allow the person with ASD to interact in their own way and helps to recognise cause and effect. Music Therapy Music therapy is well used with people on the spectrum. This allows people an opportunity to use instruments and music to communicate, express and interact with others and is can be used to develop the auditory senses.

16. Other strategies, cont Sleeping difficulties How hard do you find it getting to sleep – imagine if you had additional sensory difficulties – what would you do? You could use; Blackout curtains Heavier blankets Listen to music while drifting off to sleep Clothing difficulties May turn the clothes inside out to avoid seams or labels – if so, cut the labels out and help client to choose the clothes they like Pressure on the skin may be too much for some – find clothes that they like to wear and stick to that type of material if looking for new clothes Chewing Some individuals chew regularly as it helps them to relax. Find items that are safe and comfortable to chew – sugar free sweets, straws etc Eating Are there foods you don’t like the taste or texture of – what are they? Some of the individuals we support arethe same. Start with smaller portions, introducing textures and tastes slowly and encourage activities involving the mouth – using whistles, blowing bubbles etc

17. Further reading Now that you have read through this grab and go pack, please follow the links to the right to read in more detail, not forgetting to share this information with your team! National Autistic Society - http://www.nas.org.uk/http://www.nas.org.uk/ The Makaton Charity - http://www.makaton.org/about/ss_what.htm http://www.makaton.org/about/ss_what.htm Pyramid – providers or PECS - http://www.pecs.org.uk/index.htm http://www.pecs.org.uk/index.htm Autism Speaks - http://www.autismspeaks.org.ukhttp://www.autismspeaks.org.uk Treating autism - http://www.treatingautism.co.uk/http://www.treatingautism.co.uk/