• Collaborative

Foster the autonomy of my child with ASD or cognitive development disorder

Mathilde Canavesio, Keissa Sefiane, Cécile Testud (special educators) Dr Anita Beggiato and Dr Valérie Vantalon (child psychiatrists)

Center of Excellence of Neurodevelopment Disorders - Robert Debré Hospital, Paris


Autonomy allows a child to manage by himself on a daily basis. Autonomy is gradually acquired in several areas of daily life. It affects physical skills, thinking, acquiring knowledge, interacting with others, managing emotions etc.

Acquiring autonomy is not an easy thing for a child with an autism spectrum disorder (ASD) or with a cognitive development disorder, because these disorders impair various skills necessary to understand and realize alone tasks of daily life. Lack of attention, cognitive problems, communication difficulties, sensory and motor disorders: all these are disorders linked to autism, and interfere in the acquisition of autonomy.

Indeed, motor difficulties can put the child in difficulty to dress or lace his shoes alone.

Hyper or hypo-reactivity to sensory stimuli can cause difficulty in washing.

Stereotypies and restricted interests can hinder the child's discovery of new activities.

Learn to dress, wash, play, work alone ... Here are some tips, adapted to this period of confinement, so that you can help your child maintain their level of autonomy or acquire a little more autonomy in different situations.


Maintain my child's level of autonomy

1. Inventory of skills according to the time of day

Different times of the day such as meals, washing, dressing, homework, play etc. require skills from my child. They were stimulated by myself and by the different professionals.

The idea is to be able to maintain my child's level of autonomy before confinement and in as many areas as possible.

For this, it can be helpful for me and the whole family, during this particular daily life, to establish the list of my child's skills for each key stage of daily autonomy.

Example of a half day:

BREAKFAST:

→ eats their bread alone

→ drink milk alone by the glass

→ knows how to request an additional ration

TOOTHBRUSHING:

→ accepts having their teeth washed without protest for 5 minutes with an electric toothbrush

DRESSING:

→ takes off his pajamas alone after being asked

→ puts on a pair of jogging pants and a sweater that opens at the front


INDEPENDENT GAME:

→ uses their structured play crates for 15 minutes alone

LUNCH:

→ eats alone with their cutlery

→ drinks alone by the glass

→ wipes their mouth alone

→ spontaneously requests an additional ration

→ sit at the table for 15 minutes

→ can make a choice for their dessert

→ can refuse a food or signify that they no longer want it by pushing away with their hand

1. Reinforcement of achievements

The reinforcer is a concrete reward offered to my child when they make efforts.

This must be visible and decided beforehand.

It must be a real source of motivation for my child and above all it must be kept and accessible only during these moments of effort.

In addition, it is important to encourage and congratulate my child, this is also very reinforcing :)!

· If my child is young or has difficulties understanding

When I feel that certain skills are fragile or if I fear a regression, the establishment of a visual timetable with reinforcers can be interesting. Therefore, I ask for his motivation to do things!



· If my child has a good understanding and can read:

A token table can be drawn up over the week.

The accumulation of these points then allows my child to obtain an important reinforcer at the end of the week!

I favor their cooperation and I do not hesitate to make this painting with my child and make it attractive to them! Weekly autonomy goals can also be considered together and adapted from week to week.

This type of table can also be applied and personalized to other siblings if they wish!

https://www.debrechildpsychiatry.org/post/how-to-keep-my-child-motivated-during-the-lockdown-token-chart-or-token-economy-system

Clearly write down the objectives and rewards in the table.


Ex:

My motivation chart

Objective of the week:

Earn a minimum of 20 smileys to buy a Dragon Ball Z manga



1. Select the priorities

If my child has a lot of difficulty maintaining their level of autonomy:

· I try to select the skills that will improve the quality of family life during confinement

· I reduce the objectives to the maximum

· I will not be too demanding in order to preserve my child's motivation and cooperation (my goal is to simplify everyday family life!)

Choosing two goals seems reasonable.

For example: - falling asleep alone

- occupying themselves during 5 minutes

Increase my child's level of autonomy: the example of a meal

1. I do the inventory of their skills according to the time of day

· They stay at the table for 5 minutes and get up

· They eat alone with a spoon half of the dish and a little bit of their yogurt

· They ask for water in a suitable way with guidance (image exchange)

· They wipe their mouth alone when necessary on request

2. I identify the skills I want to work / increase

· Stay at the table for 7 minutes

· Eat half of their hot dish and all their yogurt alone

· Ask for water appropriately without guidance at least once during the meal

· Wipe their mouth at the end of each meal (I guide them using a visual sequence of steps)

3. I set up a procedure for learning autonomous behaviors

➔ I set up a visual schedule of autonomous tasks

➔ I visually place a source of motivation (reinforcer) at the key planning stages

➔ I remind by verbalizing it, whenever necessary, the objectives to reach for my child, with the associated motivation (reinforcer)

➔ I physically guide my child when necessary

➔ I don't forget to encourage and congratulate my child!

Zoom on autonomous play during confinement

1. The place of self-stimulation

Self-stimulation sometimes has an important place in the lives of people with autism. During this confinement period, access to this type of activity must remain possible and may increase for my child, but it must remain under my control.

It is sometimes even useful to use these self-stimulation as a reinforcer and to limit their access over time:

→ For further: https://www.debrechildpsychiatry.org/post/how-to-manage-self-stimulations-of-my-child-with-autism-with-or-without-intellectual-disability

2. Space adapting to guide play or independent activity

· Before you start:

- To optimize my child's concentration, I can set up their desk facing a bare wall to avoid all distractions

- To set up autonomous play, I choose a time when my child is calm and available

- I use short duration games that my child can do well on their own. The proposed games must have an end (puzzles, make a tower of 5 cubes, thread 10 beads, etc.)

· Implementation of the activity:

- I use a visual aid (for example an activity band):

→ Each activity is represented by an image on the tape. I make sure to adapt the number of activities to my child's ability to concentrate. They must not be in trouble to keep their motivation!

→ The last image on the tape is chosen by my child or by myself in the event that they cannot make a choice. This image therefore represents their reward!



- I organize their desk:

I place on the left the stacked games in the order of the activity band

I place on the right (on the desk if it is big enough or on the floor) an empty box where your child places the completed activity there. They can then remove the image of the activity carried out to go to the next one, and so on.

- Guidance:

At first, it may be necessary for me to bring physical guidance to my child (I stand behind them, like their shadow, and accompany their gestures without speaking) to show them the sequence of tasks. Then gradually fade away my guidance and my presence until my child is able to do it alone!

1. The time limit for autonomous play

Certain visual tools such as the timer, the hourglass, or a simple kitchen timer provide children with an understanding of the passage of time. These supports then make it possible to anticipate and signify the cessation of an activity or of the reinforcer.

Profits:

→ find one's bearings over time;

→ estimate a duration;

→ reduce intolerance, frustration with change;

→ anticipate and control behavioral disorders

Repeated use of these tools generally improves behavior:

→ Attention disorders and motor instability decrease

→ Anxiety and behavioral disorders, often generated by a lack of benchmarks, are better controlled

During the first tests, stopping a task is sometimes difficult (https://www.debrechildpsychiatry.org/post/how-to-deal-with-oppositional-behavior-and-rage-attacks-during-confinement)

But this strategy, repeated over time, improves your child's understanding and therefore the behavior.

48 Boulevard Serurier, 75019  Paris France

©2020 by Dr. Benjamin Landman. Child Psychiatry, Robert Debre Hospital - Paris