ACCOMMODATION CHECKLIST FOR
CHILDREN WITH AUTISM



Courtesy of: Occupational Therapy Associates - Watertown P.C.

Sensory Processing:

Each of us is continually taking in a processing sensory information (touch,smell, taste, visual and auditory information and movement) from both the environment and our bodies.  The nervous system must scan this information and quickly determine which sensations are important for self-organization and for acting on the environment.  At the same time, the nervous system must filter out and ignore unnecessary input.  Children with autism frequently have difficulties with this filtering process, resulting in extreme sensitivity to sensory information.  The child may respond by demonstrating fear, avoidance, or by striking out at the bothersome input.  Repetitive stereotypic movements, often seen in children with autism, may be a means of shutting out irritating sensations or of providing organizing input.  Sensory accommodations can assist in regulation and organization and can help to decrease negative reactions to sensory input.

Deep pressure and heavy work activities or strong information to the muscles and joints (proprioception) is generally calming and organizing.  Many behaviors, common in autistic children, such as jumping, repetitive running, head banging, chewing on nonfood objects, biting or hitting self or others, or hand flapping may be the result of a need for this kind of input. The following are ways to productively provide organizing input:

    -    Firm hugs and snuggling, pressure to the top of the head, shoulders or feet, and massage may be helpful.  Follow your child's lead and let his/her responses tell you what works best.

    -    Wrapping your child in a blanket or a piece of lycra spandex provides deep pressure to most of the body.  Wrapping arms in ace bandages may help decrease self-biting or scratching.

    -    Vibration provides strong proprioceptive input.  Children often enjoy holding a massager, using a squiggle pen, or sitting on a vibrating cushion.  Using an electric toothbrush provides this input to the mouth on a daily basis.

    -    Oral input can also be provided using crunchy or chewy foods such as bagels, carrots, pretzels, lavasch crackers, dried fruit, chewing gum, or fruit rolls.  Whistles, kazoos, party blowers, and making "raspberries" also provide good input to the mouth.

    -    Squeezing objects such as hand exercise balls, theraputty, a kneaded artists' eraser or a balloon filled with flour provide input to the hands and can facilitate attention.  For children who like to manipulate small objects, there is a large selection of "fiddle toys' at most toy stores.

    -    Your child can wear a backpack, hat fanny pack or place heavy things in his pocket.  A fanny pack filled with putty provides deep pressure and a readily available object to squeeze.

    -    Help your child to engage in heavy work such as pushing, pulling or carrying heavy objects.  Jumping on a firm pillow or trampoline, riding bicycles or other riding toys, hanging from monkey bars, swimming and horseback riding are all great "heavy work" activities.

    -    An older child may benefit from a supervised exercise program which could include weight lifting, running or use of aerobic exercise equipment such as a stairmaster, exercise bike or treadmill.

    -    For the child who seeks a great deal of movement, try providing movement experiences throughout the day.  It may help to wake your child 15 minutes earlier before school and allow her to jump on the bed or to swing.

    -    Use of a "Sit and Move Cushion", a wedge-shaped, air-filled cushion that allows subtle movement, may decrease fidgeting while seated.

The following suggestions may be helpful in reducing potentially bothersome sensations:

    -   Keep visual and auditory distractions to a minimum.  It may helpful to have a quit space in your home with a reduced number of toys.  A small tent, a table covered with a blanket, or a large empty box works well as a quiet "fort".  A carpet can decrease noise and a bean bag chair or pillows can provide comforting deep pressure.

    -    Be aware that bright lights or the flicker and hum of florescent lighting may be disturbing.  Use lamps and other lighting alternatives. Children who are highly sensitive to light may prefer to wear sunglasses.

    -    For the child who seeks out repetitive visual stimulation (i.e. spinning objects, finger flicking), try redirecting to activities that are interactive while combining vision and movement such as blowing bubbles and chasing them, water play and ball games.

    -    Prepare your child for sudden noises.  Vacuum and use other noisy appliances while he is out.

    -    Unexpected touch can be difficult for children who are sensory defensive.  Approach your child from the front and provide a warning before touching.

    -    Be watchful during stimulating group activities such as birthday parties, family gatherings, recess or lunch time at school, trips to malls or playgrounds.  Your child may be bothered by the large amounts of multiple sensory input inherent in these situations.  Allow your child to sit or stand on the outskirts of the group and move in as he feels comfortable.  It may be helpful to initially spend a short time in these settings, increasing the time as your child's comfort level increases.

    -    To help a child who is oversensitive to smells, use unscented detergent and shampoo.  Do not wear perfume or use car or stick-up air fresheners.  Use unscented markers.

Social Relating and Interacting:

Social interaction is one of the many challenges of autism.  Difficulties tolerating sensory input, understanding language and reading non-verbal cues contribute to difficulties relating socially to others.

Social interaction is easiest when your child is in a calm, alert state.  Encourage interaction when your child is engaged in activities that provide organizing input.  Look for signs of increasing organization--improved eye contact, decreased repetitive motor actions, increased vocalization and appropriate attention.  Be aware, however, that the nervous system can quickly become overloaded resulting in distress, emotional outbursts and aggression.  Watch carefully for flushed face, perspiration, high pitched or loud voice, increased speed of movement, decreased eye contact, lack of vocalization and poor attention.

    -    Many autistic children find it very hard to maintain appropriate eye contact.  It may be helpful to understand that your child may be engaged and listening to your voice without looking you directly in the eyes.

    -    For the child who frequently engages in self-stimulatory activities, try redirecting by substituting an interactive movement activity (i.e., hold hands while jumping).

    -    For the child who is organized by swinging, push you child from the front of the swing to encourage eye-contact (many children like to have their feet pushed).  Talk to your child while swinging or sing familiar songs, pausing to allow your child to fill in known words.

    -    For the child who likes rough house play and deep pressure, try "sandwich squeezes" with heavy pillows.  Encourage your child to lift, push and carry the pillows while you intermittently put them between pillow "sandwiches".  With all rough house play, follow your child's lead, allowing him/her to be in control and giving her/him time to respond to you and to initiate his/her own interactions.

    -    Encourage interactive play by following your child's lead and elaborating on his/her ideas and themes. (i.e., turn repetitive door closing into a game of peek-a-boo).

    -    To encourage responsiveness and interaction, speak to your child with animation and sometimes exaggerated affect.  Crate absurdities in play, such as a tea party involving pouring sand or beans from upside down down cups.  "Play "dumb" and allow your child to correct the situation.

Praxis (Motor Planning) and Organizational Strategies:

Praxis or motor planning is the ability to plan, organize and sequence novel activities.  It affects the child's ability to purposefully explore the environment, to play in a productive manner, to achieve independence in self-help skills and to develop age-appropriate motor skills.  Children with motor planning problems do not like to change their motor plans, and therefore, often have difficulty varying their play, accepting the ideas of others and transitioning between activities.

    -   Familiar routines are very important for children with motor planning difficulties.  Whenever possible, develop home routines and warn your child in advance of changes.

    -    Scripts or stories that explain new routines are very helpful for children with autism.  Take pictures of your child's daily activities and use them to develop a script for each week.  Write a new script for a new activity such as a family vacation, or the first day of school, and read it several times with your child.

    -    Give simple step-by-step directions for novel activities using your child's most efficient modality (i.e., verbal, visual, hand-over-hand).  Help your child identify the steps needed to accomplish the task.  It can be very helpful to ask another child to model the new activity.

    -    Using pictures hung on the refrigerator or a velcro board can help remind your child of the sequence of daily activities.  When the activity is finished, the picture can be placed into an "all done" box to help with the transition to the next activity.

    -    Use visual cues for transitions.  A timer that clearly shows the passing of a prescribed time can help your child to anticipate the end of an activity.

    -    Describing familiar routines, such as "First we ate our lunch, then we....etc", can help children understand the sequence of activities.  Asking questions such as "What do we need to do first, next...?" can help children with difficulty in initiating and sequencing tasks.

    -    Work on motor sequencing by expanding on your child's typical motor activities.  For example, if your child likes to jump, suggest that he/she jumps three times and then land in a pillow.  Try adding climbing over a tool, running around a chair, etc. Verbal cues, such as "Jump, jump, jump wheeee!" can be helpful.

    -    Encourage pretend play by adding fantasy elements to your child's usual play ideas (ie., pretend ripped paper is food for a stuffed animal).

SELF-CARE

Children with autism frequently have difficulty with self-care tasks due to problems tolerating sensory input and difficulties with motor planning.

    -   For the child who has trouble falling asleep, try giving the child flannel sheets and a heavy comforter or sleeping bag to sleep under to provide heavy weight and deep, calming pressure.  Many children benefit from having a stuffed animal to hug.

    -    A quiet tape of "easy listening" music, ocean sounds or white noise may be helpful.  Some parents report that their children fall asleep more easily when the humidifier is turned on and making a soft hissing sound.

    -    For the child who is over-sensitive to food in his or her mouth, try giving ice pops or frozen juice ice cubes to desensitize the mouth.  Carefully applied firm pressure around the mouth prior to eating may also be helpful.

    -    Your child may have strong preferences for foods of similar tastes, shapes or colors.  Introducing new foods slowly may work. It may be helpful to use preferred foods to entice children to try novel foods.  For example, try hiding chicken in yellow cheese, or make "green eggs and ham"  by adding food coloring to the eggs before cooking.

    -    To improve self-feeding, use a weighted fork or spoon and non-slip surfaces under plates, i.e. dycem mats. The weight gives the child enhanced sensory feedback about where his arm is in relation to the body.

    -    To decrease tactile distractions, turn socks inside-out and remove tags from shirts.  Eagle brand socks do not have a toe seam.  Some children prefer either tight or loose-fitting clothes; follow the child's lead.

    -    When cutting hair and nails, give firm pressure to the head, shoulders and fingers.  Electric toothbrushes sometimes help children who do not like tooth brushing.

    -    To help with showers, try a hand held shower head to control pressure and spray and keep water out of the child's eyes.  count to 10 while holding a washcloth over your child's eyes when rinsing hair.  This will prepare your child for the water and let him/her know when it will be done.

    -    When getting out of the bathtub, use a large towel to wrap child tightly.  Rub your child with the towel or loofah sponge to decrease tactile defensiveness.

    -    Set clothing out on the bed in a row to help with dressing. Have your child take articles from left to right.  Label or attach pictures to drawers if needed and rearrange them top to bottom in order of first to last items needed.

    -    When riding in the car, your child may benefit from having an objet to squeeze a piece of theraband or stretchy fabric to pull or gum or other resistive food to chew.  Stick on window shades can cut down on bothersome sunlight.  Ginger (candied ginger, ginger snap cookies or ginger capsules) can help with car sickness.


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