A Reflection on the Year

photo credit: Shandi-lee via photopin cc
I will always look back on the year 2012 as a year of life changing decisions, and a year of following my dreams.  I am so grateful to be doing something that I love to do, and something that I'm completely passionate about.  I love working with children, and I love learning about the complexities of autism.  I had dreamt about starting my own practice for a few years, but this year was the magic year when my dream would become a reality.

I love that I get to work with these amazing children and their families, I am so grateful for all the families that have welcomed me into their lives.  I am grateful for the relationships I have with the families that I have worked with in the past and the families I am currently working with.  My life is definitely better because of each and every one of you.

I hope that as you look back on 2012, you can say that it truly was a good one.  One of growth and learning, one of challenges and accomplishments, one of happiness and love.


Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Treatments for Children with Autism

Autism Therapies Comparison

This is a great form that the PLAY Project has for parents who are interested in learning the differences between Play-based therapies and Behavioral therapies.
Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Treatment for Children with Autism

Get Involved - Autism Council of Utah

If you are looking for ways to get involved in the Autism Community in Utah, this is a great way to do it.  The Services Committee is having a meeting and you're invited!  The Services Committee is a forum for parents and providers to meet and learn about services in the community, identify gaps in services, and research available services that are not listed on the Autism Council website.

Date: Monday, January 7, 2013
Time: 10am - 12pm

I will be there, and I'd love to meet you!  Please come and join us.

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Treatment for Children with Autism

Merry Christmas!


With Love,

Theory of Mind and Autism

photo credit: Olaf_S via photopin cc
When I was first learning about Theory of Mind, I was told a little scenario to help me understand.  It went something like this.

Two children are in a room with an adult.  The adult puts a teddy bear in a red box.  Child 1 leaves the room.  Child 2 watches the adult move the teddy bear from the red box to a green box.  Where will Child 1 think the teddy bear is?

A young child (usually 0-3 yrs old) will say that Child 1 will think that the bear is in the green box because they know that's where it is.  A child who has developed theory of mind will know that Child 1 will still think that the bear is in the red box because Child 1 did not see the adult move the bear.

Children with autism, oftentimes have a very difficult time with Theory of Mind.  This is one of the reasons that participating in pretend play, and talking about emotions and feelings is important for children.  However, developmentally, a child needs to be ready to participate in pretend play...trying to get a child to participate in pretend when they are not at that functional developmental level yet,  will not be beneficial.

Here is an article that I enjoyed about Theory of Mind.

Joy Mano
Utah P.L.A.Y. Project Home Consultant
Early Intervention Treatment for Children With Autism

Christmas Chaos and Autism

Mano Family Christmas 2000 (I'm the one holding the baby, next to my Grandma)
Can you believe that next week is Christmas?  This year has just flown by.  I love the holidays, I love spending time with my family, and I love our family traditions.  For some, the holidays are our favorite time of year, but for others it can be too much.

I want to talk about a few reasons why the holidays can be rough for a child with autism, and some ideas you may want to consider as Christmas and New Years are coming soon.

Most children with autism are more successful when their life is predictable.  They usually like routine, schedules, and familiarity.  So here are a few reasons why the holidays may cause stress for them.
  • parents are stressed about the holidays
  • school routines are disrupted by holiday events
  • school is out for a week or two
  • the house is decorated differently
  • lots of sugary treats around (they probably won't complain about this part, but still it's a change in diet)
  • everywhere you go, there seems to be a crowd of anxious people (stores, driving, family gatherings)
  • there are lights everywhere (a lot of kids actually enjoy this part, but to some it may be overstimulating)
  • parties to go to
  • late nights
  • weather changes
  • weather changes = wardrobe changes
  • a big scary guy with a white beard and red suit keeps following you around (everywhere you go, there he is)
  • I'm sure this list could go on and on
Of course you can't eliminate a lot of these things, but there are somethings that can help a child to cope through these changes.  My advice would be to predict the times that are going to be the most difficult and make a plan of action.  

I will give you an example.  On Christmas Eve, my whole family (extended family included) gets together.  There are usually about 50-60 of us at my Aunt's house.  We have a nice dinner, people are everywhere upstairs and down.  After dinner we have a Christmas Talent Show where each family participates.  Then we end it with a pinata for the kids.  The whole thing screams over-stimulation.  Here are some things I would do to help plan for this night without having to miss one of the best nights of the year.
  • Have a designated room in the house that could be a "quiet spot" when it's needed.
  • Have some toys/dvds/music in there that are favorites.  This is a stressful time, you want some comfort zone activities that your child can enjoy.
  • Arrive a little early so your child can get used to the home if they're unfamiliar with it.  That way you're introducing things a little at a time instead of all at once.  First the new environment, then all the people.
  • If being around a lot of people is overwhelming for your child, have people go in one or two at a time to interact with your child.  You still want them to have some social time that's enjoyable.
  • If your child can tolerate the noise and people, just be sensitive to when they need a break, and allow them to have it.
  • Our Christmas Eve party is a tradition, so we do the same thing every year and we have it at the same place.  We have a lot of pictures, so I would make a picture book about Christmas Eve.  Then a week or two before the party, I would spend time (every day if possible) looking through the pictures and describing how the night goes.  Even if your child has delayed language, seeing the pictures and having you describe it is still important.  This will help things become more predictable.  
  • During the party, I would make sure I still had the picture book with me.  Then during transitions I could get the book out and talk about what's going to come next.
This blog is still new, so I'm not sure who's reading it, but I would love to hear what you do for the holidays to help cope during the chaos :)

Joy Mano
Utah PLAY Project Home Consultant
Early Intervention Treatment for Children With Autism

Setting Events - Figuring out Difficult Behaviors

photo credit: blmurch via photopin cc

When I was the Program Director at a Care Center for people with disabilities, I worked a lot with managing difficult behaviors.  I was usually called in to work with someone after the staff had already been working with that person for a while, and they needed help.

Sometimes figuring out why someone is doing something is difficult, especially if that person does not talk.  Their behavior is how they communicate, and our responsibility is to figure out how to interpret their behavior.

You may be familiar with the Antecedent-Behavior-Consequence form that is used a lot when parents/professionals are faced with difficult behaviors.  If not, I will definitely blog about it another time.  With that form, you look at what happened right before the behavior, what the behavior looked like, and what happened immediately following the behavior.  This is a good way to start noticing patterns, and how to help an individual.

One thing that sometimes is missing is the Setting Events.  These are things that may have happened previous to the antecedent, and could be anything from medication changes to going to bed late or even having a bad dream.  We've all had it happen to us, where our day is thrown off because of something that may have happened the night before, or maybe we got a phone call that made us upset, but we don't erupt until hours later when everything appears to be unrelated.  Those are Setting Events.

Here is an example of why understanding Setting Events can be important.  There was one day that one of the residents (I'll call him Simon) was refusing to eat.  The staff did everything they could think of to get him to eat, but he would not eat.  The dining hall was almost empty, and Simon had not even started eating.  This was a concern because of health issues, so it was important that Simon ate his breakfast.  It wasn't uncommon for Simon to refuse to eat, but generally the staff could get him to eat without involving me. For some reason today was different.

I'm not totally sure everything that the staff tried before they asked me to come assist, but I know they had been trying for probably about an hour.  

When they came to me to ask for help, I immediately asked them if Simon had a belt on.  Now, to an outsider, that probably seems like a very odd question to ask in this situation.  What does a belt have to do with eating breakfast?  The staff said that he did not have a belt on, so I asked them to get him his belt and if he is still refusing to eat then I would come in and help.  I'm sure that they thought I was crazy, but a few minutes later the staff reported that Simon was eating.

So what does a belt have to do with eating breakfast and how did I know that that was the reason why Simon wasn't eating before I even went to check on him?  I had worked with Simon for a couple years, and I knew that he had a very rigid routine that he would follow every day.  If that routine was interrupted, he wouldn't complain, but he would start over.  Simon usually moved at a very slow pace which was opposite the pace that the staff was working at, and oftentimes Simon would be rushed.  Usually rushing Simon had the opposite effect because he would have to start over, so in essence he took even longer.  I had noticed a few days/weeks prior to this incident that Simon had become very attached to his belts, and he always had to be wearing a belt.  If he did not have a belt, then his day would be ruined.  

So one of the Setting Events was that Simon was rushed and he did not have a belt on.  The Antecedent was that he was given breakfast, the Behavior was that he was refusing to eat, and the Consequence was that the staff did everything they could do to try to convince him to eat.  You can see why Setting Events can be important, and why being aware of routines, environment, etc., can be key to your observations.  Without the setting events, our conclusion could have been he was avoiding eating, maybe it was a sensory thing with the food, or maybe he wanted something else.  It could have been that he was doing it for attention.  Those would have been good guesses, but they were wrong that particular day.  

Sometimes it's the obvious, but when what you're doing isn't working, it might be something less obvious.  This is also a reason why communication is important between parents and teachers.  I was always so grateful when parents would call me (when I was teaching) to let me know that something happened at home, or the child missed breakfast, or that they changed medications.  That information can be very useful when you are trying to decipher why there may be a change in behavior, or why what you used to do doesn't work any more.

Joy Mano
Utah P.L.A.Y. Project Home Consultant
Early Intervention Treatment for Children With Autism

Autism and "The Stare"

photo credit: tbone_sandwich via photopin cc
Let's talk about "the stare" for a second.  I'm not talking about a stare you might receive from a child with autism, I'm talking about a stare you might find someone giving someone else when their child is acting out in public.

Here's some food for thought:

  • A child with autism has the same physical features as a child without autism.
  • If a child with autism is approached the same way that a child without autism is approached when they are having a meltdown, the opposite reaction of what is expected may take place.  (This could be why a parent is not doing what one may think they should be doing.) 
  • Autism is NOT and never has been caused by bad parenting.
  • Giving a child the opportunity to have new experiences in various environments is important in that child's development, even if it ends up in a meltdown.
  • Most people are able to go to the store without the constant fear of something going wrong, and most people take it for granted.  
  • The majority of communication is done through body language.  "The stare" can be judgmental and demoralizing.  The definition of demoralizing is to deprive a person of spirit and courage...to destroy morale.
I recognize that there are other instances (besides meltdowns) when families receive the unwarranted "stare" and I will address that in a future post.  The purpose of this post is for all of us to take a step back and check ourselves.  Ask yourself if you've ever found yourself giving "the stare" and then ask yourself how you would want people to react if you swapped places.

Joy Mano
Utah P.L.A.Y. Project Home Consultant
Early Intervention for Children with Autism

Types of Play & How it Relates to Autism

There are different phases of play that a child will go through as he/she is developing.  How long a child stays in each phase is dependent on the child, but each stage is important because a child will learn valuable skills as they learn to play and play to learn.

In general, there are 6 different stages of play as defined by Mildred Parten.
  1. Unoccupied Play-this is when a child is not playing, but may be observing others.  The child may stand in one spot or perform random movements.
  2. Solitary (Independent) Play-this is when a child can focus and pay attention to the activity they are involved in.  They are usually unaware or uninterested in what others are doing around them. The child explores and usually experiments with cause and effect behaviors.
  3. Onlooker Play-this is when a child may observe what others are doing and may make comments to those participating, but does not actually join the play.
  4. Parallel Play-this is when children may play next to each other with like materials, and may imitate each other's actions, but they are not necessarily playing togethers.
  5. Associative Play-this is when children may be interested in each other and socializing together but they do not have an organized activity they are participating in together.  They may be in a group interacting, but they are all doing their own thing.
  6. Cooperative Play-this is when children are interested in each other and in the activity they are doing together.   They will have an organized activity with assigned roles as they work together cooperatively.
So what does this have to do with autism?  Well, no matter who the child is and what his/her strengths and weaknesses are, these stages of play are still important in their development.  Some children may get stuck at one level or another.  There are many children who do not know how to participate in solitary play because they get stuck in the Unoccupied Play stage.  There are others who are stuck in the stage of Onlooker Play.

Some children need more assistance and encouragement to move forward through these stages, and as parents, family, educators, therapists, etc., we have the great privilege of helping these children by teaching them how to play!

I love that I get to teach kids and parents how to play.  Sometimes when there is a skill (like playing) that usually comes natural to children, it can be tricky figuring out how to break things down to teach that skill to a child.  That's one of the reasons I love the P.L.A.Y. Project, it gives families the methods and techniques they need to help their child progress through those developmental stages that every child needs to go through.

Joy Mano
Utah P.L.A.Y. Project Home Consultant
Early Intervention for Children with Autism

photo credit: RESchroeder via photopin cc

How autism was explained to me

The first time I remember learning about Autism was when I was working at a summer camp for people with disabilities in Salt Lake City, Utah.  We were preparing for a week when several of the kids coming had autism.  They had someone come in to talk to us counselors about autism.  At this point in my life, I had already been working with people with various developmental disabilities, but none of the people I had worked with had autism.

I don't remember the name of the lady who came to talk to us, but I remember one of her explanations of autism.  This was back in 2004.

It went something like this:

Imagine you are in a foreign country, maybe Russia or something like that.  You're going along minding your own business when suddenly all these people start coming towards you.  They're saying something and they look upset but you don't understand them.  They start raising their voices as if that will help you understand what they're saying, but you don't speak their language.  They start waving their arms, and you can tell they're upset, but you still don't know why.  How are you supposed to fix it when you don't know what happened?  So, what do you do?  Fight or flight.  You may curl up in a ball, hiding your face from them.  You may plug your ears to tune them out.  You may start screaming back at them in your own language.  You may try to run away.  You may start doing something to help yourself calm down.    We all react in different ways.

You can see how this situation may be a bit frightening, uncomfortable, and intimidating.  She went on to explain that this may be how some of these kiddos are feeling.  Sometimes they don't understand our language, or our culture.  We may get upset because they did something that according to us was not right, but they may not understand why.  And sometimes even when we are explaining it to them, we are not speaking the same language and they still don't understand.  When they become overwhelmed and frightened, they may start doing things like plugging their ears, screaming, running away, rocking, looking away, etc.

When she told us this scenario, my eyes were opened.  I felt like this didn't just apply to autism, but to a lot of situations.  It put me in a situation that I could imagine myself in, and it made me have more empathy for all the people I had ever worked with and would work with.  As Temple Grandin said in her presentation the other week, her "fear center" is 3 times as big as is expected in a brain.  Can you imagine how certain situations that may seem "normal" to us can be very frightening for someone with autism?

I don't know how accurate this little story is, but I'm grateful for it because it changed me early in my career as how to approach various situations and how to have more empathy for those reacting differently than I would to those situations.

Joy Mano
Utah P.L.A.Y. Project Home Consultant
Early Childhood Autism Intervention

 photo credit: massdistraction via photopin cc

Eye Contact

It's really quite amazing how much we use our eyes to communicate.  We can know if someone is happy, sad, annoyed, tired, mad, etc. all by looking into someone's eyes.  We can point with our eyes, we can show interest in something (or someone), we can say "come here", we can say "help", we can say a lot with just a tiny movement of our eyes.  Our eyes are not only used to be able to see the amazing things in our world, but also to express how we are feeling about our world.

There are many individuals with autism who lack eye contact.  It can be difficult for those trying to communicate with these individuals, and they may feel that they are being ignored or that the individual is not paying attention or is distracted.  That's usually what we would think if someone is not looking at us when we are speaking to them.  There may be various reasons why someone with autism may not give eye contact, but it's not always because they're ignoring you.

So, the question is...should we force eye contact?  Should we focus on making a child give us eye contact when we're talking to them?  There may be some that disagree with me, and that's fine, but my answer would be no.  The eye contact is not the underlying issue, communication generally is.

I'm not talking about speech here, I'm not talking about being able to form words with our mouths, I'm talking about back and forth interactions, gestural communication.  

As we focus on those back and forth interactions, you will usually find that eye contact improves.  I'm not saying it's going to be perfect, but it will generally increase.  As a child starts to find you more interesting, realizes that their actions and words have power, and that they want to see your reactions, you'll see that they will look to you more often.

Need some ideas on where to start?  There are a lot of place you can start, but here's just one idea.  Try interacting using sensory motor activities.  Activities/toys that involve a lot of visual stimulation can be very difficult to compete against, you want to make the environment a place where YOU are more exciting than the flashy toys around you.

Here are 10 sensory-motor activities you can try starting with
  • wrestling
  • jumping together (on the trampoline, couch, bed, where ever)
  • burrito wrap - get a large blanket, roll the child up, then start adding "topping" and give him/her a lot of deep pressure, then "eat" him/her up.
  • bury him/her with pillows
  • throw him/her onto the couch and wait for him/her to ask for more
  • chase
  • build a tower of pillows and run together and knock it down
  • play stop and go while you spin him/her on an office chair
  • swing him/her in a blanket
  • crawl through a tunnel (this blocks out other distractions and they can look at you at the end of the tunnel as they crawl towards you)
Find an activity that your child will want more of. Play, play, play, and then pull back a little to see if your child will initiate more.  Don't force him/her to say more, watch their gestures and take them as cues.  Don't discount gestural communication, it's the beginning of communication skills and it's part of the foundation that they need to strengthen.

Joy Mano
Utah P.L.A.Y. Project Home Consultant
Early Childhood Autism Intervention


Jed Baker, PhD, the author of No More Meltdowns, and Social Skills Picture Book came and presented with Temple Grandin at the Utah Autism and Aspberger's Conference last week.  I really enjoyed his presentation on behavior and social skills.  He has great ideas, and you can tell he has made a big impact on many lives through the people he has worked with one on one and also through his presentations to parents and professionals.

One of the main themes of his presentation was HOPE.  Why do we do what we do? Hope.  How is it that we get through the hard times and we endure the challenging behaviors?  Hope.  We may work and work and work with a child whether they are a student or your own child, we will continue to find ways to work with that child because we have HOPE that what we are doing is making a difference for that child, and that's what makes everything worth it.

There was so much information in this presentation that I won't be able to convey it all right now, so I'm just going to point out one other thing he talked about.  He said "90% of teaching and parenting is tolerance."  We have to be able to "tolerate our own discomfort long enough to think about what to do."  "The individual's behavior is not intended to simply challenge your authority, but is rather a reflection of his/her lack of coping skills."  He went on to say that "our responsibility is to teach a child coping skills, not to establish a hierarchy."

Dr. Baker also talked about the 20/80 rule.  80% of kids, your average rules and consequences will work.  However, it's those 20% of kids that you need to re-evaluate what you're doing and change your interventions accordingly.

Something else that I think is very important is trust.  Dr. Baker said, "It is very hard to impact another human being without trust."  This where we always need to start.  Every relationship should start with trust.

Here is a list of Jed Baker's books
Social Skills picture books
Social skills training for children and adolescents with Aspbergers syndrome 
Preparing for life
The social skills picture book for high school and beyond
No more meltdowns

Here his DVD

Social skills training and frustration management

Joy Mano
Utah P.L.A.Y. Project Home Consultant
Early Childhood Autism Intervention

Notes from Temple Grandin's presentation

Temple Grandin spoke at the Utah Autism and Aspberger's Conference last week on November 30, 2012 in Provo Utah.  When she began her presentation, she started by talking about the importance of Early Intervention.  She said "the worst thing you can do is wait." "I cannot emphasize the importance of early intervention and one on one interactions."

Temple Grandin was diagnosed with autism when she was 2 years old.  She attended a structured nursery school which she feels helped her early in life.  When talking about her early life and her recommendations, Temple Grandin said:

  • A good teacher is gently insistent
  • Early intervention is essential
  • Children should have a minimum of 20 hours weekly of one to one teaching
She went on to talk about the different sensory issues and how these systems can be affected in every day life, and especially in learning.  Temple said "my mind works like Google for Images."  This is part of the reason she has been so successful in her line of work.  She continued to say:
  • All my thinking uses specific examples to create concepts
  • It is bottom up thinking and not top down thinking
  • I learn ALL concepts using specific examples
Many people with autism have difficulties with generalization of skills.  Temple said for her the more experiences she would have the more information she could put in her database (in her head) and the more she could make those generalizations.  She explained "It is memorization and scripting, but as more information is memorized, it can be assembled into more and more categories which will help thinking to become more flexible.

It was a great presentation, and I was glad I was able to go.  I think one of the things that surprised me and will help me have more empathy for some of the children I work with is she said "Fear is the main emotion in autism.  My amygdala (fear center) is three times larger."  I don't think that many people understand this fact, we don't understand why some kids react the way they do.  Their fear may be 3 times larger than another child their age.  We need to help them feel safe so that they can experience things and learn without that added stress.  This is one of the reasons that Temple invented the squeeze machine.  This helped her to be able to control the deep pressure that she needed and "helped reduce anxiety and panic attacks."

Temple Grandin has many books available, and there is also a movie that came out in 2010.

Here is a list of her books

Here is the DVD
Temple Grandin

Joy Mano
Utah P.L.A.Y. Project Home Consultant
Early Childhood Autism Intervention