Question 5: Take Home Strategies

When working with children with ASD, keep in mind that children with ASD have a lack of understanding of emotion and decreased recognition of facial expressions.  Children with autism do not have a good ability of recognizing emotion, as discussed in my previous posts, therefore, when you use your facial expressions as rewards or praise they will not understand.  For example, when the therapist smiles when the child does a “good job” in OT, the child may not understand that this means they did a good job. This was discussed in my first post, how children with autism process emotion differently than typically developing children.  They also have difficulty reading emotion on faces and in general use a different scan pattern when looking at faces (Gautheir, Klaiman, Schultz, 2009).

As stated previously, children with autism have difficulty understanding emotion in facial expression. Teaching children to label faces of different emotion and practicing making those faces are shown to improve children’s understanding of different emotions on faces, as stated in Ryan and Charragian (2010) article.  Also, sorting different faces with different emotions on them are helpful in having the child understand emotional expression.

Having difficulty understanding emotion affects the child’s ability to make friends, sustain friendships and get a job, as stated in my first post.  Therapists need to address these needs.  If we are working on prevocational activities or socialization goals, part of what we should address should be the emotional and facial processing skills of these kids.  These skills are vital in interviewing, sustaining a job, and making and keeping friends. (http://www.emotionalprocessing.org.uk/Various%20articles/Autism.htm#Autism_and_Emotional_Processing)

Lastly, this is an area where family education is important. Parents need to understand that sometimes their child may not understand what emotion they are displaying on their face and not react appropriately. Giving the family a variety of ideas to teach these skills, as stated in my previous post, for home use, will aid greatly in helping them form relationships with their children.

This is my last question to answer on my blog. I hope everyone has learned something from reading this blog. Please post any questions that you have for me so I can address them all on my next posting…thanks!

Question 5: Home Program

Provide 2 family focused home programs which will help families either help their child compensate OR drive them to a higher level of ability and efficiency in emotion/face processing

      Ideas for home activities for families:

·         Have a poster of different faces all representing different emotions, along with pictures of family members and friends expressing different emotions. Review daily with child what each emotion is and what it means. 

·         Throughout the day when mom is upset, happy, frustrated, have the child “guess” the emotion and reward as appropriate.  If time allows, you can even have your other children join in the game to guess other emotion.

·         Have a game where you each try to make different faces and guess which emotion you are portraying; discuss how that emotion makes the child feel.

·         Have child point out on board of faces how they are feeling that day and see if they can identify why they feel that way.

·         Read stories, such as, Bernstein Bears and talk about how each person would feel in the story and how you can tell.

·         Parents can play this online “feelings” game with child: http://specialchildren.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=specialchildren&cdn=parenting&tm=6&gps=308_237_1362_521&f=10&tt=13&bt=1&bts=1&zu=http%3A//www.do2learn.com/games/feelingsgame/index.htm

·         A good idea on the website: http://www.parentingscience.com/facial-expressions-for-kids.html is to match pictures of situations with pictures of the emotion is would make you feel.

·         This website:

http://www.thomasandfriends.com/usa/Thomas.mvc/Games/Home  has two games: one choose the right emotion and one matching emotions.  It could be done at home and the family could talk about when you would feel each emotion.

Question 4: Intervention Strategies

    Provide 3 clear strategies to modify your activities to compensate for these challenges. Reference any research available to support these strategies.

    

Superflex: A Superhero Social Thinking Curriculum Package

                This is a program designed for children with Aspergers and high functioning autism to improve on social skills.  It is about a superhero Superflex and how he deals with different social situations.  The program also helps to understand different people’s emotions.  Below is the link for some information on Superflex.  This can be a great program to implement in school. I know they have used this program at different districts and the kids love it. It would primarily be taught by a teacher, but we could easily carry it over into our treatment sessions by if a situation of social thinking comes up, you can ask, what would Superflex do or,  if working on fine motor skills, you can color in Superflex and talk about social situations. 

http://www.socialthinking.com/index.php?page=shop.product_details&flypage=flypage.tpl&product_id=129&category_id=9&option=com_virtuemart&Itemid=102

Matching components and faces of different emotions

                A study by Ryan and Charragain (2010) taught children with high functioning autism emotional recognition through a variety of tasks within small groups, the children were taught to match faces with different emotions and sort different components of faces based on the emotions.  For example, they not only labeled happy faces, but also, happy eyes and mouths. This study found this technique to be effective in teaching recognition of emotions.  We could easily incorporate this into our treatment session if we are working on sorting, categorizing, or body awareness. 

Role playing emotion expressions

In the Ryan and Charragian  (2010) study, they also had the children practice role-playing different emotion expressions and drawing expressions to improve ability to recognize emotion.  These we could easily incorporate in our treatment sessions, if we are working on pencil skills, we could have children draw different expressions, or if we are working on any facial exercises we could incorporate naming emotions of the faces we are making.  This intervention was found to improve children’s recognition of emotion. 

Conclusion

Overall, I think we have to be aware of the fact that children with ASD do not understand emotion in the same way we do.  We have to be aware to not use our expressions to guide behavior and use our expressions as rewards.   Also, explaining how you feel to the child, for example, if you are disappointed they did not follow a direction, tell the child how you feel and ask them how they can tell that is how you feel.  We can use pictures of different facial expressions that show, happy , sad, and angry faces in treatment ,  to show how the therapist and/or child is feeling.

Reference

Ryan, C. & Charragain, C.N. (2010). Teaching Emotion Recognition Skills to Children with Autism.  J Autism Dev Disord 40: 1505-1511.

Question 3: Clinical examples

Provide 3 clear examples of clinical situations in which your treatment approach is challenged by a child’s reduced or inavailability to process emotion and facial features.

When working with a student on a task, for example handwriting, and they do not want to complete the task, I usually offer a reward or try to make it “fun”.  Sometimes, the student still becomes frustrated with the task and difficulty attending and therefore will run away or act out.  If this child could process emotion typically, I would show the child I am upset with my facial expression and tell them to sit down. However, this does not work with children who cannot understand what my expression means or why I am having an “angry” or “disappointed” emotion. I have to come up with a different way to control the behavior this child, which we have discussed throughout our modules.

When trying to get a student to try a new task that may be difficult for them, for example, use shaving cream to write letters.  Usually, I would act excited for the child to try the new sensory texture and smile and say how much “fun” it is going to be, but if the student does not process the smile and happiness, this is not a valid way to prep the activity. 

When on a swing if the child starts to tip the swing and do anything unsafe, I usually will say “stop!” with a little fear and some sternness in my voice, however, if the child does not understand my look of fear and the “fear” in my voice, they might stop the action as quickly. With my other students, they understand this and don’t do this again, but with these students, I have to come up with a different approach.

Working in groups is also more challenging.  Usually working in a group, I might have the children play a competitive fine motor game; this type of play means understanding when someone wins/loses to be kind to them and involves lots of social interaction. However, when working with two children and one does not understand emotion, I will start off with parallel play, then turn taking and then a competitive game

I often use my “happiness” as a reward for the student, for example, after they complete a task saying good job with a big smile can be a big enough reward, however, with a child who has difficulty understanding emotion, this would not be the best reward, a tangible item would have better results.