Apraxia and Autism: Where to Start

Because I think I’m generally hilarious, I decided that an unofficial subcategory of “Take That, Autism!” shall be “In Your Face, Apraxia!” because we’ve got more than one challenge on our plate.

I’ve talked to you about what Childhood Apraxia of Speech is and incidence rates of it in children with Autism here. Now, I want to tell you about what we’ve been working on and how to prepare ourselves for “true” intervention for apraxia.

Caleb says so many things that aren’t jargon, but true productions that are just that unintelligible. Because apraxia. Apraxia makes vowels beastly to form, consonants the trickiest of the tricksters, and then when you go to put those Consonants and Vowels into various CV, VC, CVCV, CVC, etc. sound combinations it all can become a very “say what?” situation. And that’s when you’re able to imitate things verbally on a 1:1 compliant ratio. But what about when you have Autism and are 3 and your verbal skills are just starting to develop and your ratio of imitating a single word is more of a 20:1 input/output ratio? And that’s just to maybe label…..NOT to produce specific sounds in specific sound patterns.

But your child wants to try. You can tell. They want to try to say more things. Where do you start? Here’s where we’re at.

Imitation Hierarchy

There are sooooo many things kids imitate before they imitate at the word level. Here’s the breakdown:

– Gross Motor Movements (jumping, kicking, etc. and then expanding to movements with objects such as rolling cars)

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Fine Motor Movements (clapping, motions to songs, playing with small objects and tools, etc.)

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– Oral Motor Movements (blowing, sticking out tongue, kisses, etc.)

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– Imitation of nonsense or environmental sounds (moo, vroom, etc.)

– Imitation of single sounds and simple words

I could not expect Caleb to say “car” if he wasn’t rolling a car across the floor or knew that it went “vroom.” And this hierarchy is not profound. It’s typical language development, really. The difference is that in typically developing kids, the first 4 steps usually don’t need to be “taught”. You probably don’t know when your child started imitating actions, play, animal sounds, etc. because they just kind of did it. Everything with Autism takes more work , more time, and a lot of times formal intervention to learn. Caleb did not imitate rolling a ball. It was taught. He didn’t start imitating motions to songs until last summer right before he turned 3. And it took a lot of watching YouTube song videos and hand-over-hand until he knew his own head, shoulders, knees, and toes. You can’t just look at Caleb and say “stick out your tongue”. It has to be this very elaborate back and forth in front of a mirror where ridiculous faces are made and you will ultimately end up getting lizard licked. Right now we’re teeter tottering between imitating nonsense sounds, single sounds, and 1 syllable words. Caleb can do some solid “ahhhhhhh”, “eeeeeee”, “oooooo” imitations to practice vowels and early developing consonants are coming through, but we are not ready to imitate sounds at the word level. We’ll get there, but it’s a marathon, not a sprint.

I wanted to review a solid imitation hierarchy because when we have 4, 5, 6, year olds who are not yet talking it can be very instinctive to just throw words at them and hope they stick. But imitation of movements, actions, and sounds are a crucial part of development. And if those skills didn’t develop, they need to go back and be addressed and facilitated. That does not mean; however, that you should not work on talking about all of the things all of the time. While you’re working on learning actions, talk about them. When you’re playing trucks, make truck sounds. You’ll get some back sometimes and that’s awesome. You don’t want to walk before you crawl. And I know parents get jazzed and bragged “my child didn’t crawl, they went straight to walking and walk just fine!” but I promise you don’t want that. Yes, maybe they’re walking now but if they never learned that crawling step, there could be implications one day of never having learned the proper skills needed for appropriate visual-spatial recognition, motor coordination leading to good handwriting, and a host of other things (which is a whole other post for a whole other day). Same principle applies here. Imitating actions contributes to increased attention to task, appropriate play development, improved eye contact and social interaction, etc. Do you want to skip straight to talking and skip all those other important developmental milestones? Probably not. No matter what your child’s age, it’s never too late to go back and start working on those skills.

Please stay tuned for future updates on Caleb and our Apraxia-Autism interventions (that will challenge mommy’s creativity and ingenuity) as we find the strategies and approaches that he’s going to respond best to. Thanks for being a part of our journey.

Love, Autism, and Apraxia, everybody. Here’s to the feeling of satisfaction we’ll have when we end up where we’re going to end up and the patience for us to hold on tight until we do.

Erin

Haircutting Tips and Tricks

Haircutting Tips and Tricks

Krystal Showers MSOS, OTR/L

Haircutting is one of the most difficult routines for children, especially boys, with autism. It is consistently an area that parents mention is so difficult for them, and a nightmare for their children. When we stop and break it down, it is easier to understand why this routine in particular sends so many households into panic. Families literally plan out haircutting day/ night, recruit support via extra hands and bodies to help, amp themselves up for what it means with meltdowns, and prepare to deal with a half-buzzed head for a while if need be!

Let’s look at haircutting from a sensory processing perspective first before we get into some tips and tricks!

Auditory

This is the big one for our friends with autism. I had one child describe the sound of high pitched noises, like the buzz of clippers, as “a sharp needle that stabs all the way into my brain”. Think- how would you like that right up next to your ears, let alone tolerate it for a good 15-20 minutes without becoming upset! Children with autism often have very sensitive hearing and can have difficulty filtering out noises. The sound of clippers can be unnerving, especially in a barber shop where there may be more than one pair going at a time or multiple people talking at the same time.

Tactile

Haircutting involves vibration tactile input which may be aversive to the child. What we may consider as a “tickling” sensation from the vibration, may actually feel like sandpaper or pins and needles. Even if you are using regular scissors, the light touch of their hair falling on their neck or skin can feel painful and like they are being stabbed with each tiny hair.

Movement/vestibular

Many children with autism have a high need for movement. Sitting still in a seat for a haircut can be very difficult. For children whose vestibular or movement sense is very poor, sitting still can be almost impossible as they crave movement as a basic need….just like food when you are really hungry!

Smell

If your child is getting their hair cut in a salon or barber shop there can be a LOT of smells in one small space. Children with autism can have a very sensitive sense of smell and can respond negatively to smells that others may not notice or be bothered by. With all the different people, shampoos, conditioners, dyes, etc., it can be a lot to take in!

How to make this routine easier for you and your child!

Auditory Strategies

  • Use scissors to cut hair rather than clippers
  • Provide headphones and music the child can control to help block out clipper sounds
  • Try haircuts at home or during very slow times of the day at a barber shop to decrease the amount of sounds in their environment

Tactile

  • If you have been trained in the Deep Touch Pressure Protocol by your occupational therapist doing the brushing protocol prior to haircuts will help your child stay calm and decrease some of the sensitivity to touch
  • Try to cover ALL the skin that stray hairs could land on using a towel or smock
  • Let the child experience the vibration from clippers on their hands first (ie: let them hold the clippers without the blade on so they can feel and get used to the vibration
  • Before starting, provide some deep squeezes to the child’s head (like a firm head massage) moving down to shoulders and arms as well to help prepare the child and give some calming input

Movement

  • Use a move-n-sit cushion during haircutting so they child is able to get some movement but still stay in their seat
  • Engage in intense swinging, spinning or bouncing prior to asking the child to sit for a haircut
  • Take short movement breaks to stand and jump and then sit back down

Smell

  • Try haircuts at home or during very slow times of the day to limit the number of extra smells the child is exposed to
  • Bring a small cloth with a favorite smell on it (ie: lavender or peppermint essential oils) for the child to hold up to their nose when the other smells become overwhelming

 Here’s a video of Caleb getting his hair cut. Check out his sweet cape!

Caleb gets super duper fly.

And here’s a video of Caleb cutting daddy’s hair!

Daddy’s gets what he dishes out. 

Choices, Opportunities, and Success

Choices, Opportunities, and Success

As the website grows so does the audience and reach of posts. We’ve also just received a lengthy communication disparaging everything Take That, Autism! stands for. While we will certainly not respond to all posts like this in the future, this provides a good opportunity to more specifically state what Take That, Autism! is about.

I wish my wife had saved the message she received as I would have posted it here for all to read but the gist of it was that Take That, Autism! is anti-autism and parents should not be providing any interventions to help their children succeed, especially by encouraging children to make eye contact with other people. Also, that my wife is too “neurotypical” to see how much these interventions damage children with autism. To channel my best friend from New Jersey, “Are you kidding me bro?!!”

Take That, Autism! is my wife’s creation and I cannot speak for her. Speaking only for myself, Take That, Autism! is about doing what any parents want to do for their children: providing our children as many opportunities as possible to succeed. I do not want my son to feel limited in his choices for success as an adult. If my son knows to make eye contact with others as an adult but chooses not to, that’s fine because he made that choice. If we don’t provide him tools for success in the form of interventions then we are severely limiting his choices as an adult. I want my son to have the choice of sitting in the boardroom of a Fortune 500 company, trying cases as a lawyer, or saving lives as a doctor. He can’t do these without making eye contact. We have a farm and I would be equally proud if he wanted to stay here and try to make a living off it. Even on a remote farm in the country, he’ll still be more successful selling cows, tomatoes, or grizzly bears if he can look a customer in the eye and give them a firm handshake. The same goes for virtually every way to make a living including electricians, entrepreneurs, welders, and hoteliers.

Lets note that I’m talking about reasonably attainable choices for an individual child. I’m not going to have my 3 year old practice golf for six hours each day to give him the choice of becoming a PGA pro. Similarly, autism is a wide spectrum and ultimate opportunities are going to vary for each child. For some, the goal may be any job at all that can provide some sort of satisfaction or semi-independence. It may even be just the ability to convey what food is desired for a meal or that a bathroom is needed. It is unbelievable that anyone could hold the viewpoint that parents are wrong to provide interventions that help children with autism tell their parents what they want to eat or that they have to use the bathroom. It is beyond me that some people are capable of thinking this way, let alone actively deride parents doing everything in their power to help their children have choices in life.

I could write a book about why this attitude is so wrong and damaging but let’s wrap this post up and maybe we’ll continue in another one day. To sum up, Take That, Autism! is about parents providing choices and the best opportunities for individual success for their children with autism. Whatever path in life they choose will ultimately be up to the child but we will do our best to provide them with as many options as possible. The choices and opportunities are going to differ for each child, and that’s okay, but we’re still going to do the best we can because our children deserve nothing less.

Brian