Doctors Office Intervention for Kids With Autism

We all know that visits to the doctors office can be difficult, I addressed some of those reasons in my post about sensory overload and the doctor's office.  Today I want to share an experience that one of my student's parents told me about their visit to the doctor.  We'll call this child John.

John hated going to the doctor, it just wasn't a pleasant experience for him or anyone that went with him.  John's mom said that usually both of them would leave the doctor's office crying, it was just a horrible experience.  That changed.

Here's what they changed at their doctor's office.

  • First, John's doctor sent him a story which included pictures of the doctor's office and a play by play story of what would be happening.  It also included pictures of the nurses and the doctor that he would be visiting.  John's mom read this story with him several times before his visit to the doctor.
  • Next, John's mom was allowed to check in as they were driving to the doctor's office.
  • Since they already checked in, when they arrived to the doctor's office, there was no waiting.  They immediately took John back.
  • Prior to the visit, John's mom filled out a questionnaire that included what John's high interest was.  John's favorite toys were Toy Story toys.
  • The nurses used Buzz and Woody to help John with transitions.
  • John used to get very upset when he had to be weighed, but this time the nurse showed John how Woody was going to be weighed first.  She narrated what was going on, so when it was John's turn, he was excited to get weighed and did it without a problem.
  • Once John got to the room he was assigned to, there was no waiting!
  • John's nurses and doctor basically used PLAY to make John feel comfortable, and to help him to follow directions.  John's mom said it was amazing.
  • The best part was that both John and his mom were able to leave the doctor's office without a tear :)
I was so impressed with this doctor, and I wish that more people could implement some of these simple techniques in order to help more children have successful experiences out in the community.

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

Show And Tell -- Tip Tip Dig Dig

Happy Show And Tell Day!

First off, I love Emma Garcia's books.  They're so much fun.  One of the reasons I fell in love with her books is because my students loved them so much.  Many of my students who didn't usually participate in circle time would imitate all the actions for this book.  It's so simple, it has good repetitive lines the kids could repeat, and nice action words that could be acted out.

A lot of kids with autism love cars or trucks, so this Tip Tip Dig Dig is kind of perfect as far as an attention getter.  If you are working on imitation skills, this book is motivating.  If you are working on actions words, it's also a good one.

A couple other Emma Garcia books that I love are Toot Toot Beep Beep, and Tap Tap Bang Bang.  Check them out!

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

Sensory Overload - Autism and the Doctor's Office

Sorry!  I meant to post this earlier.

I was trying to think of instances when someone might be excited to go to the doctor.  I asked a friend, and she came up with a few.  When a woman is going to find out if she's pregnant, when you're having a procedure done that will make your life lasik eye surgery, when you know it's the last time you have to go after a long series of visits (but my guess is that you're more excited about the prospects of not having to go again rather than actually going.)  Ok, I guess there's a few, but let's be honest...even these visits cause a lot of anxiety.  When I had lasik eye surgery done, they offered Valium for the anxiety.

My visits cause anxiety.  And let's recall from my post about the brain, that the amygdala (it's weakness being low tolerance for stress and anxiety) is 4 times as big in a individual with autism.

Ok, so here goes my list of some (not all) reasons why going to the doctor can cause sensory overload for some kids (and adults) with autism.  In a future post I will share an experience that one mother shared with me of how her doctor made it such a successful visit with her son with autism.
  • The anxiety of going to the unknown
  • This trip is not part of my daily routine
  • When we arrive, we have to wait to check in
  • Mom or dad is filling out paperwork instead of paying attention to me
  • I get yelled at every time I walk away 
  • Florescent lights flickering
  • Phones ringing
  • TV playing, but it's not my favorite show
  • Waiting to see the doctor
  • Someone calls my name, and we are taken through a door to the unknown
  • They make me stand on a scary looking machine to weigh me, but I don't know what that means
  • I get in trouble when I don't stand still on the scary machine
  • I am taken to a little room, and I have to wait...again
  • They make me sit high in the air on some crinkly paper that doesn't feel good
  • It smells weird
  • There are objects around me that don't look familiar
  • A stranger comes in and gets in my space, looking at my eyes, in my ears, in my mouth, etc.
  • This same stranger has a some weird things coming out of his ears and he wants to put it on my heart, but I don't know why.  It's cold and uncomfortable.
  • Sometimes another stranger comes in with pokey things and she stabs me with them, and it hurts
  • After I cry for a while, I get to leave

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

photo credit: Joe Shlabotnik via photopin cc

Show and Tell: 10 Little Bumblebees

It's Friday!!!  That means I get to share one of my favorite things.  This week I want to share with you one of my favorite circle time songs.

I think one of the reasons I like this song so much is because I love the props my staff helped me make. They're so cute, and so easy to make!

What you need: black gloves, yellow duct tape

As you can tell from the picture we just took strips of tape and put them around the fingers.  We also made cute little antennas, but if I were doing it again, I would just forego that part.  Most of them were either ripped off or chewed off.

Why I love this song and the props, in no particular order :)

  • We're learning about numbers
  • Putting on gloves is good fine motor work
  • Getting tactile input from the soft gloves
  • Learning to tolerate gloves for the winter season
  • Kids ask for help when they need it
  • Finger isolation when singing the song
  • Imitation skills
  • Proprioceptive input with tickling.  I like to tickle when the bees are buzzing all around
  • Kids share as we have one or two students pass out the gloves
  • Clean up, learning to put things away and waiting a turn to put their props back int he box
  • Attending.  Music is always a great motivator for attending and staying seated
For some reason Amazon isn't letting me add anything to my Astore today, but I'll add this song to my Amazon Favorites when I get a chance.  For now, here's a link to a sample of the song.  10 Little Bumblebees.

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

Autism and the Brain

Last week I attended an Autism Conference at Utah Valley University.  One of the workshops I attended was about the neurological difference associated with ASD.  I thought it was so interesting, and I learned a lot so I wanted to share it with you.  The presenter was Brandon Condie, BCBA, LPC.

He talked about 5 main areas of the brain, including the amygdala, hippocampus, frontal lobe, corpus callosum, and cerebellum.  The thing that I found interesting was the strengths and weaknesses of each of those areas.  It just makes so much sense if you know many individuals that are affected with autism.

Here we go.

Amygdala.  In an individual with autism, this area is enlarged.

  • Strengths include improved memory for interests and details.  Makes total sense for those individuals who know EVERYTHING about their special interest.  Makes sense for those who have Savant skills.
  • Weaknesses include a low tolerance for stress and/or anxiety.  When I heard Temple Grandin speak last year she mentioned that her amygdala is 4 times the size of a typical brain, which meant that her fear center was 4 times as big.  We see this a lot where a situation that doesn't seem frightening to us may be completely overwhelming to an individual with autism.  This explains a lot.
Hippocampus.  This area is also enlarged in an individual with autism.
  • Strengths include being logical, and is systems oriented.  Many individuals with autism excel in areas like engineering, math, etc.  We marvel at those kiddos who are unable to communicate, yet they are able to navigate things like the dvd player, ipads, computers, etc. with very little help and at a very young age.
  • Weaknesses include perseveration.  We see this in a lot of individuals with autism, once they are focused on something it is difficult to change directions.  Whether it is a topic of conversation, lining things up, or making sure everything is where they feel like it needs to be.
Cerebellum.  In an individual with autism, they may have overloaded white matter.
  • Strengths include a need for routine, and becoming an expert at a task.  As many parents know, routines and predictability are so important for individuals with autism.
  • Weaknesses include unsteadiness, delayed physical or verbal response, and anxiety surrounding sudden change.
Frontal Lobe.  The frontal lobe is enlarged due to excessive white matter.
  • Strengths include being visual learners.  Temple Grandin talks a lot about how she sees the world in pictures, and all her memories are in pictures.  That's why she's so good at what she does.
  • Weaknesses include having a difficult time with abstract thought.  This may be part of why social interactions are so difficult as well because they are not concrete.  Some of our rules as pertaining to social interactions are abstract.
Corpus Callosum.   This area is undersized.  The corpus callosum links the two hemispheres of the brains and is the source for effective communication between the two hemispheres.
  • Strengths include being able to hyper-focus on detail
  • Weaknesses include missing the "bigger picture" and being able to bring concepts together.
Learning about this information was so eye opening for me.  I've worked with a lot of kids with autism, and I see common characteristics and I know how to work with their strengths and their areas of struggle, but learning about the brain helps me to see more of the WHY. 

Joy Mano
Utah PLAY Project Home Consultant

Early Intervention Services for Children with Autism

photo credit: Patrick Hoesly via photopin cc

Repetitive Behaviors and Autism

So I've talked about the first two areas of concern in autism, which are social interactions and communication.  The last area is repetitive behaviors.

As a recap, according to the DSM IV these are the requirements for a diagnosis of autism.
  • At least two symptoms from the area of Social Interaction are present
  • At least one symptom from the area of Communication is present
  • At least one symptom from the area of Repetitive Behaviors is present
  • A total of 6 (or more) items are present from the 3 areas listed above
  • Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:
    • Social interaction
    • Language as used in social communication
    • Symbolic or imaginative play
  • The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder.
Ok, let's talk about Repetitive Behaviors.  Like I said above, at least one of the following is present.
  • Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
  • Apparently inflexible adherence to specific, nonfunctional routines or rituals
  • Stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole body movements)
  • Persistent preoccupation with parts of objects
What does this look like?

Restricted patterns of interest.  The key to this area is the intensity and focus.  We all have interests, but it is the intensity and focus on that interest that can become disruptive to every day life.  For some it may be a subject like trains, dinosaurs, trucks, star wars, etc.  It may become the only thing the individual will talk about and can have an effect on relationships and school depending on how focused they are on that subject.  For others it may be in lining things up, or matching objects.  This can affect ones life when the intensity is so strong that they have a meltdown every time things are not how they would like them to be lined up.  

Specific, nonfunctional routines or rituals.  Just like we have our own rules for things, and I'm sure that some individuals with autism don't understand our rules...some individuals with autism have their own rules and we just don't get it.  I had a student and his "rule" was that he had to enter the building through a certain door.  I didn't know about this "rule" and it took a while before I figured it out, but if he went through the right door instead of the left door (even if we already made it halfway down the hallway) he would have to turn around go back outside and come in through the left door.  This was a behavior that was specific, nonfunctional and turned into a ritual.

Repetitive motor mannerisms.  Many of us have little movements that we do when we are in stressful moments, or when we are trying to pay attention.  For example, when we are sitting in a meeting all day, we tend to get restless.  We start to bounce our leg, or tap our pencil on the desk.  Once again what this is looking at is the intensity and focus.  Many individuals with autism have repetitive behaviors that may begin as a coping mechanism for them but can easily turn into habit.  Some of these repetitive behaviors may be hand flapping, walking on tip toes, spinning, darting across the room, flicking their fingers in front of their eyes, etc.

Preoccupation with parts of objects.  Sometimes you will find that individuals with autism focus on parts of objects rather than looking at the object as a whole.  For example rather than playing with a toy car, the child may be overly focused on the tires.  Instead of using the toy functionally, they may only spin the tires.

Repetitive behaviors can be all consuming and may affect an individuals ability to function fully in their environment, however that information can be very useful as we learn to interact with each individual. 

If you have any concerns about your child's development, please contact your doctor.

Joy Mano
Utah PLAY Project Home Consultant
Early Childhood Autism Services

photo credit: KellBailey via photopin cc

Show and Tell -- Duck Duck Moose Apps

If you haven't tried the Duck Duck Moose Apps, you really should.  They are great for kids.  With familiar tunes, great animations, and interactive activities how could you go wrong?

Here's more reasons why I love the Duck Duck Moose Apps.

  • Great cause and effect applications
  • Counting games
  • A lot of actions that you can talk about with your child while he's playing.  "Hey! You made him jump!" "He's climbing his web."  Etc.
  • You can sing with it, or sing alone with the accompaniment
  • You can record your child singing it
  • Kids love it and stay engaged with the learning activities
Try some out if you haven't already.  They are between $0.99 and $1.99.

Communication and Autism

On Monday I focused on the area of Social Interactions in regards to the DSM IV (how autism is diagnosed.)  Today I'm would like to continue on to Communication.  As I said in my last post, just because someone has some of these characteristics, does not necessarily mean they have autism.  They must also meet the criteria in the areas of Social Interaction and Repetitive Behaviors.

According to the DSM IV, at least one of the following are present.

  • Delay in or total lack of, the development of spoken language (also without gestural communication)
  • Individuals with adequate speech have a marked impairment in the ability to initiate or sustain conversations
  • Stereotyped and repetitive use of language or idiosyncratic language
  • Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level
Spoken Language and Gestural Language.  Many times the lack of spoken language is the most obvious sign for parents that their child may have delays.  Typically, kids should have several  consistent words they are using by 18 months.  You would start seeing more gestural communication, like pointing, around 14 months.  Here is a great blog about language development (Playing With Words 365), and particularly, here is a post about red flags in communication.  It gives some great timelines on language development.

Initiating and Sustaining Conversations.  There are some kiddos who have tons of words they know, but making their words functional can be more difficult.  Conversations are a give and take process, we build relationships when we have good conversations.  Some kids may know how to talk, but they do not participate in a back and forth interactions with others.  Some kids are good at responding, and will answer questions, but will not go further than that.  Others will initiate, but will rarely let others respond, thus they are very good at the giving part, but not so much at the taking part.

Stereotyped and Repetitive Language.  Some parents will report that their children speak in movie quotes.  Sometimes it's in context with the situation, but a lot of times it is not.  Some kids may get fixated on certain phrases and will repeat them continuously.  Other kids will repeat what you say or other things they hear, this is called echolalia.  Echolalia includes when they immediately repeat what they hear, or they may also repeat what they heard hours ago.

Make-believe Play or Social Imitative Play.  Make-believe can be difficult for some kids with autism because it involves an understanding of what other people are feeling and doing.  It also requires imitation skills.  When playing with others in pretend play, this skill also requires that the child is able to see the points of view of other people and explain his/her point of view to them to create the experience that they want.  Many kids with autism prefer to play on their own, and may focus more on sensory type play.

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

photo credit: Diego Dalmaso via photopin cc

Social Interactions and Autism

According to the DSM IV (which I mentioned earlier will soon be DSM-5 as early as May 2013), at least two of the following are present in the area of Social Interaction when an individual is being diagnosed with autism.
  • Marked impairments in the use of multiple nonverbal behaviors such as eye contact, facial expression, body posture, and gestures to regulate social interactions
  • —Failure to develop peer relationships appropriate to developmental level
  • A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people
  • —A lack of social or emotional reciprocity
Now just because someone has some of these characteristics, doesn't mean they have autism. They also have to have symptoms in the areas of Communication and Repetitive Behaviors, which I will talk about next week.

Let's break this down a little.

Eye Contact.  Sometimes eye contact can be very aversive to a person with autism, you may get occasional glimpses here and there, but it can be fleeting.  As you go through your day, take note to how much we communicate with our eyes.  It can be very difficult to teach someone to communicate and read "eye language", it's all so subtle.  You can see how that can affect someone's social skills.

Facial Expression.  You may or may not have heard the expression "flat affect."  Sometimes individuals with autism show very little expressions through on their face.  They have the same expression when they're bored as they do when they're excited.  Other times you may find that their facial expressions are a bit rigid and unnatural.  Again, reading facial expressions can be difficult for some people with autism, but in general it's a bit easier to teach than reading the eyes.

Body Posture and Gestures.  How often do we communicate with gestures?  All the time!  Many times, young kids with autism are unable to follow a point or use a point themselves.  We point with our fingers, and we point with our eyes for joint attention.  We are having an interaction as we are both focused on the same thing.  Gestural communication is very important in our social interactions.  It is usually learned through imitation, which many kids with autism are lacking in.

Peer Relationships.  There are different types of play, and depending on the child's age, different types of peer interactions are more appropriate than others.  Usually when parents start to see the gap is when it is time that their child should start socializing with their peers (associative or cooperative play.)  For some kids, they would rather participate in solitary play away from everyone else.  Some kids are only able to play near others for short periods of time.  For other kids they may want to play with other kids, but they don't know how to join in, or they don't know how to participate.  Some kids are able to talk, but they lack the understanding that conversations should be a give and take exchange.  And some kids like playing with others, but they have a hard time when they don't have total control over the activity.  All of these things can affect peer relationships.

Sharing Enjoyment.  At a young age kids will pick up a toy to show their mom.  Typically a toddler will learn the phrase "look" or "look at me!" and will use it quite often.  Once again, that is part of joint attention.  Focusing together on one thing.  Some kids with autism will not participate in exchanges like this.

Social or Emotional Reciprocity. When we are connected to each other, we have back and forth interactions with one another.  We are able to read each others gestures, their tone of voice, their emotions, and their words.  We take these things as cues and we respond to them accordingly.  Many people with autism have a difficult time with this because they lack theory of mind.

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

photo credit: MikeWren via photopin cc

Show and Tell--Play Food

There are so many reasons why play food is great.  First it's something that the child has hopefully seen and possibly experienced first hand.  We're talking imitation skills here.  Because a child usually has first hand experience watching his mom (or dad) prepare food, he/she is able to have an idea of what to do with this food.  This is where pretend comes in.  First it will just be imitating the motor actions, but then it can turn into thematic play.

This particular food is great because it also incorporates fine motor skills.

So here's my list of things to do with play food in random order (aka, however it comes to my mind)

  • Have a picnic
  • Feed stuffed animals or puppets
  • Play the "like it"/"don't like it" game.  Make funny faces as your child "feeds" you, and over exaggerate when you like it or don't like it.  Then do the same thing with the puppets
  • Match the pieces of food that go together
  • Match the food to pictures of the food
  • Categorize the food
  • Cut the food and prepare a meal
  • Be a waiter and take the child's order or vice versa
  • Make a stew
  • Set the table before you eat
  • Have a tea party
  • Plant the food in a sandbox or sensory table

Symptoms of Autism

We are all different.  Agreed?  Yes, we may have some similarities, but we are still very different.  The person that I am probably the most like is my best friend, sometimes it's scary how much we think alike.  But, we are still very different.  One big difference is our career paths, I work with kids with autism and she is an accountant.  My sister-in-law is an identical twin, yes her and her sister look very similar, but they are very different.

What does this have to do with the symptoms of autism?  Well, I just want to emphasize that just because two people have the same diagnosis, they are individuals and are most likely very different from one another.  And although two people may have deficits in the area of communication does not mean that their deficits look the same.  It's a spectrum.  The diagnosis of autism is based on observation, and to be diagnosed with autism, the individual does not need to have 100% of the symptoms.

There are 3 common areas that are affected in individuals with autism.  They include social interaction, communication, and repetitive behaviors.  I will go into more detail about each area in upcoming posts.  If you have any concerns though, please contact your doctor.

Whether your child has a diagnosis or not, the thing that I think is important is that you find out where your child needs the most help and you put your efforts there.  I believe that individualizing the treatment is far more important than saying autism=a specific type of intervention.  There is not yet a cure for autism, BUT there are a lot of interventions that can help an individual improve and gain skills to be able to function more fully in this crazy/wonderful world we all live in.

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

photo credit: read4thefunofit via 
photo credit: superhua via photopin cc
photopin cc photo credit: jshj via photopin cc

Happy Autism Awareness Day!

I love it when the whole world is able to come together for one purpose whatever it may be.  Today is the Sixth Annual United Nations World Autism Awareness Day.

Hopefully as you go around your community today you will see people who are shining a light on autism by lighting it up blue.  And if not, then perhaps next year you will be the one to do it.

I posted about this yesterday, but it's not too late to get a banner or logo for your facebook/twitter/pinterest/etc. accounts.  Just go to

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

photo credit: BC Gov Photos via photopin cc

Happy Autism Awareness Month!

April is Autism Awareness Month, so I would like to focus my April posts more about Autism.  I hope to be able to give some insight into the 3 core deficits of autism, which include social interaction, language, and repetitive behaviors.  

As many of you know, the way that Autism is diagnosed is undergoing some changes.  It may be as early as next month when the DSM IV (Diagnostic and Statistical Manual of Mental Disorders) will change to the DSM-5.

Here's the thing about the diagnosis changes, I am more concerned about your child as an individual.  What are his/her strengths?  Where is he/she struggling?  Regardless of whether he/she has a diagnosis of autism, I want to look at what we can do to strengthen those areas of concern.  So even though the criteria I am going to be discussing is going to be outdated next month, I'm still going to try to look at those areas of deficit and put them into terms we all can understand.

I will start those posts later this week.

Here's some other random info:

My Community Ed class that I am teaching in Sandy, Utah begins tomorrow.  You can go to or you can just show up and we can take care of registration before class begins.  It is at 6:30 pm, April 2 at the CTEC (825 East 9085 South)

Tomorrow begins LIGHT IT UP BLUE.  If you don't know what that is, check out  They also have banners and logos you can download to add to your facebook or twitter accounts.  Light it up blue is the kickoff to Autism Awareness Month around the world.  It's pretty awesome how the world comes together to help spread the word about autism.  Check out the amazing photos including The Great Pyramids, The Sydney Opera House, and many more amazing places around the world.

April 11, 2013 is the Annual Autism Council of Utah Meeting.  Everyone is invited to attend.  It will be at 9:00 am at the Capitol.