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Developmental Checklist, Milestones
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The Autistic Spectrum

Not sure if your child is developing appropriately? On this page you'll find information that should be helpful, along with a 'what happens next' list if you feel you need to have your child evaluated.



Here is a listing of characteristics/symptoms my son presented (at one point and/or still does) that I provided the doctors, therapists and teachers. You may find these helpful.

-Affectionate, happy baby; always smiling; loves to be held
-Applies same level of detail to every situation whether appropriate or not
-Comfort blanket and stuffed animal to produce calming effect
-Copies phrases/words borrowed from other situations or people
-Depending on the situation and person(s) involved, can seem aloof or overly friendly; also appears at times to be rude and antisocial with other children because of his inability to understand social complexities
-Difficulty seeing overall situation
-Difficulty understanding idioms, humor
-Difficulty with motor skills requiring visual perception accuracy: hitting baseball, going through a revolving door
-Difficulty with motor skills; cannot ride a two wheeler.
-Difficulty with transitions when changing activities
-Dislikes unexpected surprises
-Doesn't let go of emotions; an incident can determine the mood for the rest of the day and can even carry into the next day (remembers these things for years!)
-Easily overstimulated by sound, lights and crowds
-Excellent rote memory
-Extreme difficulty reading facial expression, non-verbal communication, body language, humor and emotion resulting in naive social behaviour
-Eye contact fair (getting better as he ages)
-Face blindness (difficulty recognizing faces out of the usual setting)
-Finds great comfort in rocking (he does this when he's excited, frustrated or trying to increase concentration); handflapping was another symptom he presented until he was about 7; it has decreased markedly with no prodding from us)
-Great sensitivity to clothing (a shirt that I think is soft he may find 'scratchy')
-Hand biting, chewing shirts, towels, stuffed toys, etc.
-Hard time understanding/participating in group interactions
-Has an unusual walk; sometimes clumsy
-Hurt is expressed as rage/anger
-Low self-esteem
-Makes inappropriate but very honest comments/observations
-Must follow the rules and if he sees someone breaking them, will call it to their attention
-Needs to go to his room to 'chill out' (especially enjoys listening to music)
-Outside and inside feelings don't match (covers up anxiety extremely well while in school setting)
-Over stimulated when given too many verbal directions
-Overly fearful in safe situations/no fear in dangerous situations; doesn't understand consequences
-Perfectionist
-Perseveration/obsessions early on with fans, vacuum cleaners, garage doors/door openers
-Prefers concrete rather than abstract concepts
-Pronoun reversal during his early toddler years
-Sensitive to heat
-Some attention difficulties
-Speaks loudly and quickly
-Tantrums - These didn't start until he was 8-1/2 (we -call them meltdowns; these occur when he's on overload -- too much noise, too much homework; they escalated in 4th grade and have stopped since we started homeschooling)
-The Little Professor" syndrome (sounds like an adult)
-Time concept difficulty
-Very detail-oriented
-Very sensitive to light, pain, taste, touch, smell and sound
-When younger, difficulty with writing/grip, learning to tie shoelaces

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Speech-Language Development Milestones

The order in which children learn speech sounds and language forms is fairly predictable. Most children follow the same pattern of development. When a child is developing skills in this order but is doing it more slowly, he/she has a speech/language delay. Sometimes the child does not have the same speech or language skills as other children his/her age and is not just slow in developing. They have gaps in development - they may have some skills that are age-appropriate but are missing some that should have been learned when they were younger. They may say use some sounds or forms that are unusual and never used by any child at any age. This is considered a disorder.

Children identified as at-risk or high-risk, such as those from neonatal intensive care (NICU) units, should be tested early and at regular intervals. Other risk factors include diagnosed medical conditions, for example, chronic ear infections; biological factors, for example. Fetal Alcohol Syndrome; genetic defects, for example Down syndrome: neurological defects, for example. cerebral palsy; or developmental disorders, for example, delayed language.

Children with no high-risk features should be evaluated if their speech and language is not similar to other children of the same age.

Evaluation may be formal or informal and include any combination of standardized tests; direct observation of play and interaction with caregivers; report by parent, teacher, or physician; and collection and detailed analysis of spontaneous speech samples.

Several sessions as well as ongoing evaluation may be required to obtain enough information to make an accurate diagnosis.

The early identification team may consist of the speech-language pathologist, audiologist, psychologist, neurologist, electrophysiologist, otolaryngologist, pediatrician, nurse, and social worker. Because speech-language delays and disorders may be due to a variety of causes, each professional makes valuable contributions to the evaluation.

From the results of the evaluation, certain services may be recommended. Prevention includes those children who have been identified as at-risk, for example, due to low birthweight, for a communication delay or disorder.

Services are provided before a specific diagnosis has been made. Remediation increases function in areas identified as delayed or disabling and may serve to prevent other related problems. For example, remediation of a language disorder can help to offset learning difficulties. Compensation enables the child and the family to make adjustments for limitations, as in some cases of cerebral palsy.

Language is taught in a natural setting. It is presented at the child's developmental level; responses are consistently stimulated; and output is rewarded. Play may be used to teach communication, language models or rules of conversation, such as turn taking.

Feeding and swallowing treatment may be needed to sustain life. It can also be used to encourage speech-like movements, stimulate sound production, or increase the child's awareness of speech movements.

If you are concerned about a possible speech-language delay or disability, consult a speech-language pathologist. A list of certified speech-language pathologists in your area may be obtained by calling the American Speech-Language-Hearing Association's (ASHA) toll-free HELPLINE at 1-800-638- 8255.

If you have concerns about your child's development, talk with a professional such as a pediatrician. New born and young babies listen and respond to your voice and other sounds; they tell their feelings by cooing, gurgling, smiling, and crying. Your 3-month-old should respond to your voice and other sources.

3 to 8 month old babies play with sounds and they babble to themselves. They use sounds to communicate (smiling a the sound of a happy voice, and crying or looking unhappy on hearing an angry voice). Babies can play peek-a-boo. They wave arms and kick feet to show excitement, and they enjoy being read to. Your 8-month-old should make several sounds, reach for and grasp objects.

Crawlers and Walkers (8 to 12 month old babies) understand and respond to gestures, facial expressions, and changes in tone of voice. If someone asks, "Where's Mommy?" babies will look for their mother. Babies understand simple words, such as "Da Da." Babies put books in their mouths and turn pages in sturdy books. Your baby should look at people who talk to him or her and should be pointing at or making sounds to get what he or she wants, like favorite toys.

12 to 18 month old babies say first words. They understand a few words and simple directions. They know their own names. They will give you a toy if you ask for it. Babies create long babbling sentences and look at picture books with interest. If your 18-month-old does not say more than a few words clearly, s/he should be seen by your doctor.

Toddlers (18 to 24 months old)put two or more words together to make short sentences like "want juice" or "car go." Toddlers learn new words quickly. They can copy adult sounds, words, and motions. Toddlers ask and answer simple questions. They can use crayons and markers for scribbling.

Your 20-month-old should be able to follow a simple request, such as, "Come to Daddy."

Your 24-month-old should use two words together.

24 to 36 month old toddlers listen to stories being read. They like to play pretend games. They love asking "why" questions. They use "no" and "not" a lot. Toddlers enjoy looking at picture books, turning pages, and naming objects they see. Their scribbling is becoming more like writing.

Your 2-year-old should ask questions or respond to simple questions with "yes" or "no."

Preschoolers (3 to 4 years old) make comments and requests, and tell others what to do. They can talk about things that happened and make up stories. They listen attentively to stories and retell stories themselves. They enjoy books that tell about real things as well as make-believe. They may revert to toddler behavior when feeling upset or shy. They make shapes such as circles and squares and pretend to write the way they have seen adults write. Your 3-to-4-year-old should use language freely, experiment with verbal sounds, and begin to use language to solve problems and learn concepts.

Preschoolers (4 to 5 years old) know the names and sex of family members and other personal information. They play with words and make up silly words and stories. They are beginning to draw figures that represent people, animals, and objects. They understand that pictures, numbers, words, and letters are symbols of real things and ideas. They 'write' as a way to tell stories and offer information. They enjoy "reading" on their own. They may recognize a few words such as their name or words on signs.

Children 5 to 6 years old can recognize and reproduce many shapes, letters, and numbers. They are gaining control over writing and drawing tools. They understand that letter written on a page represent spoken words. They use invented spelling (tp for top, Mry for Mary). They dictate stories for others to write. They enjoy using computers. Work with your child's teacher to assess his or her language skills through the elementary school system.


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Motor Skills Milestones

There are two categories within the area of motor skills: gross motor and fine motor. Gross motor skills deals with large muscle groups such as walking. Fine motor incorporate the small muscles such as writing.

By Age one:

Gross Motor
~sits without support
~crawls
~pulls self to standing position and stands unaided
~walks with aid
~rolls a ball in imitation of adult

Fine Motor
~reaches, grasps, puts object in mouth
~picks things up with pincer grasp (thumb and one finger)
~transfers object from one hand to the other
~drops and picks up toy

Between ages one and two:

Gross Motor
~walks alone
~walks backwards
~picks up toys from floor without falling
~pulls toys, pushes toys
~seats self in child size chair
~walks up and down stairs with hand held
~moves to music

Fine Motor
~builds tower of three small blocks
~puts four rings on stick
~places five pegs in pegboard
~turns pages two or three at a time
~scribbles
~turns knobs
~throws small ball
~paints with whole arm movement, shifts hands, makes strokes

Between ages two and three:

Gross Motor
~runs forward well
~jumps in place with two feet together
~stands on one foot (with aid)
~walks on tiptoe
~kicks a ball forward

Fine Motor
~strings four large beads
~turns single pages
~snips with scissors
~holds crayon with thumb and fingers (not fist)
~uses one hand consistenly in most activities
~imitates circular, vertical, horizontal strokes
~paints with some writst action; makes dots, lines,circular strokes
~rolls, pounds, squeezes, and pulls clay

Between ages three and four:

Gross Motor
~runs around obstacles
~walks on a line
~balances on one foot for five to ten seconds
~hops on one foot
~pushes, pulls, steers wheeled toys
~rides tricyle
~uses slide independently
~jumps over six inch high object and lands on both feet together
~throws ball overhead
~catches a bounce ball

Fine Motor
~builds tower of nine small blocks
~drives nails and pegs
~copies circle
~imitates cross
~manipulates clay material (rolls balls, snakes, cookies)

Between ages four and five:

Gross Motor
~walks backward toe-heel
~jumps forward 10 times without falling
~walks up and down stair independently, alternating feet
~turns somersault

Fine Motor
~cuts on line continuously
~copies cross
~copies square
~prints a some capital letters

Between ages five and six:

Gross Motor
~runs lightly on toes
~walks on balance beam
~can cover 2 meters hopping
~skips on alternate feet
~jumps rope
~skates

Fine Motor
~cuts out simple shapes
~copies triangle
~traces diamond
~copies first name
~prints numerals 1 to 5
~colors within lines
~has adult grasp of pencil
~had handedness well established
~pastes and glues appropriately

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Do you suspect your child has special needs? Here are the chain of events that should occur:

1. Identify the child as needing special education and related services. (Make a detailed list of all areas in question, behaviors, etc.)

2. Have child evaluated.

3. Child's eligibility is decided.

4. Child is found eligible for services.

5. IEP meeting is scheduled.(In this meeting should be the parents, regular education teacher, school system representative, special ed teacher, and a person who can interpret evaluation results...and any other person(s) with knowledge or special expertise about your child such as Occupational Therapist, Speech Language Pathologist, even an aide).

6. IEP meeting is held and the IEP is drafted. (Contents of the IEP should include the child's current performance, annual goals, special education and related services to be provided, an explanation (if applicable) explaining the extent to which the child will not participate with nondisabled children in the regular class and other school activities.) Related services include: audiology services, counseling, early identification and assessment of disability, medical services, o/t,orientation and mobility services, parent counseling and training, p/t,psychological services, recreation, rehabilitation counseling, school health services, social work services in school, speech/language pathology services and transportation. Before the school can provide a child with special education and related services for the first time, the parents much give their written permission.

7. Services are provided.

8. Progress is measured and reported to parents.

9. IEP is reviewed and revised (after 1 year).

10. Child will be re-evaluated after 3 years.

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POTTY TRAINING ARTICLES
 
 
Frequently Asked Questions about Autism
Temple Grandin, Ph.D.
Assistant Professor
Colorado State University
Fort Collins, CO 80523, USA
 
1. How do I know if my child has problems with sensory over sensitivity?
Sounds or visual stimuli that are tolerated by normal children may cause pain, confusion and/or fear in some autistic children. Sensory over sensitivity can vary from very slight to severe. If your child frequently puts his hands over his ears, this is an indicator of sensitivity to noise. Children who flick their fingers in front of their eyes are likely to have visual sensitivity problems. Children who enjoy a trip to a large super-market or a shopping mall usually have relatively mild sensory sensitivities. Autistic children with severe sensory sensitivities will often have tantrums and other bad behavior in a shopping mall due to sensory overload. These children are the ones who will most likely need environmental modifications in the classroom. Older children and adults, who remain nonverbal and have very little language, often have more severe sensitivities than individuals with good language. Children with auditory or visual sensitivity will often have normal hearing and visual acuity tests. The problem is in the brain, whereas the ears and eyes are normal.
 
2. What sights and sounds are most likely to cause sensory overload or confusion in the classroom?
Every autistic child or adult is different. A sound or sight, which is painful to one autistic child, may be attractive to another. The flicker of fluorescent lighting can be seen by some children with autism and may be distracting to them. It is mostly likely to cause sensory overload in children who flick their fingers in front of their eyes. Replacing fluorescents with incandescent bulbs will be helpful for some children. Many children with autism are scared of the public address system, the school bells or the fire alarms, because the sound hurts their ears. Screeching electronic feedback from public address systems or the sound of fire alarms are the worst sounds because the onset of the sound canNOT be predicted. Children with milder hearing sensitivity can sometimes learn to tolerate hurtful sounds when they know when they will occur. However, they may NEVER learn to tolerate UNexpected loud noise. Autistic children with severe hearing sensitivity should be removed from the classroom prior to a fire drill.
 
The fear of a hurtful sound may make an autistic child fearful of a certain classroom. He may become afraid to go into the room because he fears that the fire alarm or the public address systems may make a hurtful sound. If possible, the buzzes or bell should be modified to reduce the sound. Sometimes only a slight reduction in sound is required to make a buzzer or bell tolerable. Duct tape can be applied to bells to soften the sounds. If the public address system has frequent feedback problems, it should be disconnected.
Echoes and noise can be reduced by installing carpeting -- carpet remnants can sometimes be obtained from a carpet store at a low cost. Scraping of chair legs on the floor can be muffled by placing cut tennis balls on the chair legs.
 
3. Why does my child avoid certain foods or always want to eat the same thing?
Certain foods may be avoided due to sensory over sensitivity. Crunchy foods such as potato chips may be too loud and sound like a raging forest fire to children with over sensitive hearing. Certain odors may be overpowering. When I was a child I gagged when I had to eat slimy foods like jello. However, some limited food preferences may be bad habits and are not due to sensory problems. One has to be a careful observer to figure out which foods cause sensory pain. For example, if a child has extreme sound sensitivity, he should not be required to eat loud, crunchy foods; but he should be encouraged to eat a variety of softer foods. When I was a child my parents made me eat everything except the two things which really made me gag. They were under-cooked slimy egg whites and jello. I was allowed to have a grilled cheese sandwich everyday for lunch, but at dinnertime I was expected to eat everything that was not slimy.
 
To motivate a child to eat something he does not like, it is recommended to have a food he really likes such as pizza right in front of him along with the food he dislikes. He is then told that he can have the pizza after he eats a few bites of peas. It is important to have the pizza right there in front of him to motivate eating something he does not like.
 
4. How do I toilet train my autistic child?
There are two major causes of toilet training problems in children with autism. They are either afraid of the toilet or they do not know what they are supposed to do. Children with severe hearing sensitivity may be terrified of the toilet flushing. The sound may hurt their ears. Sometimes these children can learn if they use a potty chair which is located away from the frightening toilet. Due to the great variability of sensory problems, some children may like to repeatedly flush the toilet but they are still not trained. The thinking of some autistic children is so concrete that the only way they can learn is to have an adult demonstrate to them how to use the toilet. They have to see someone else do it in order to learn. Some children with very severe sensory processing problems are not able to accurately sense when they need to use the bathroom. If they are calm they may be able to feel the sensation that they need to urinate or defecate, but if they experience sensory overload they cannot feel it. This may explain why a child will sometimes use the toilet correctly, and other times he will not.
 
5. Why do some autistic children repeat back what an adult has said or sing TV commercials?
Repeating back what has been said, or being able to sing an entire TV commercial or children's video is called 'echolalia.' Echolalia is actually a good sign because it indicates that the child's brain is processing language even though he may not be understanding the meaning of the words. These children need to learn that words are used for communication. If a child says the word 'apple,' immediately give him an apple. This will enable the child to associate the word 'apple' with getting a real apple. Some autistic children use phrases from TV commercials or children's videos in an appropriate manner in other situations. This is how they learn language. For example, if a child says part of a breakfast cereal slogan at breakfast, give him the cereal.
 
Autistic children also use echolalia to verify what has been said. Some children have difficulty hearing hard consonant sounds such as "d" in dog or "b" in boy. Repeating the phrase helps them to hear it. Children who pass a pure tone hearing test can still have difficulty hearing complex speech sounds. Children with this difficulty may learn to read and speak by using flash cards that have both a printed word and a picture of an object. By using these cards they learn to associate the spoken word with the printed word and a picture. My speech therapist helped me to learn to hear speech by lengthening hard consonant sounds. She would hold up a ball and say "bbbb all." The hard consonant sound of "b" was lengthened. Some autistic children learn vowel sounds more easily than consonants.
 
6. How should educators and parents handle autistic fixations on things such as lawn mowers or trains?
Fixations should be used to motivate schoolwork and education. If a child is fixated on trains, use his interest in trains to motivate reading or learning arithmetic. Have him read about trains or do arithmetic problems with trains. The intense interest in trains can be used to motivate reading. It is a mistake to take fixations away, but the child needs to learn that there are some situations when talking about trains is not appropriate.
 
The idea is to broaden the fixation into a less fixated educational or social activity. If a child likes to spin a penny then start playing a game with the child where you and the child take turns playing with the penny. This also helps to teach turn taking. A train fixation could be broadened in studying history. A high-functioning child would be motivated to read a book about the history of the railroad. One should build and broaden fixation into useful activities. My career in livestock equipment design started as a fixation on cattle chutes. My high school science teacher encouraged me to study science to learn more about my fixation.
 
High functioning autistic and Asperger teenagers need mentors to help them develop their talents into a career skill. They need somebody to teach them computer programming or graphic arts. A local computer professional could serve as a mentor or the individual may be able to take a programming class at a community college. Many parents wonder where they can find a mentor for their teenager. Try posting a notice on a bulletin board at a university computer science department or strike up a conversation with the man in the supermarket checkout line who is wearing a badge with the name of a computer company on it. I found one of my mentors in the business world when I met the wife of his insurance agent.
 
7. What is the difference between PDD and autism?
Autism and PDD are behavioral diagnoses. At the present time there are no medical tests for autism. Autism is diagnosed based on the child's behavior. Both children diagnosed with autism and PDD will benefit from education programs designed for autistics. It is essential that children diagnosed as PDD receive the same education as children diagnosed with autism. Both autistic and PDD children should be placed into a good early education program immediately after diagnosis. Children diagnosed with PDD tend to fall into two groups: (1) very mild autistic symptoms, or (2) some autistic symptoms in a child who has other severe neurological problems. Therefore, some children diagnosed as PDD may be almost normal; and others have severe neurological problems such as epilepsy, microencephaly or cerebral palsy. The problem with the autism and PDD diagnoses is that they are NOT precise. They are based only on behavior. In the future, brain scans will be used for precise diagnosis. Today there is no brain scan that can be used for diagnosing PDD nor autism.
 
8. Why is Early Intervention important?
Both scientific studies and practical experience have shown that the prognosis is greatly improved if a child is placed into an intense, highly structured educational program by age two or three. Autistic children perform stereotypic behaviors such as rocking or twiddling a penny because engaging in repetitive behaviors shuts off sounds and sights which cause confusion and/or pain. The problems is that if the child is allowed to shut out the world, his brain will not develop. Autistic and PDD children need many hours of structured education to keep their brain engaged with the world. They need to be kept interacting in a meaningful way with an adult or another child. The worst things for a young two to five year old autistic child is to sit alone watching TV or playing video games all day. His brain will be shut off from the world. Autistic children need to be kept engaged; but at the same time, a teacher must be careful to avoid sensory overload. Children with milder sensory problems often respond well to Lovaas-type programs.
 
However, children with more severe sensory processing problems may experience sensory overload. There are two major categories of children. The first type will respond well to a therapist who is gently intrusive and pulls them out of their world. I was this type. My speech therapist was able to "snap me out of it" by grabbing my chin and making me pay attention. The second type of child has more neurological problems, and they may respond poorly to a strict Lovaas program. They will require a gentler approach. Some are 'mono-channel' because they cannot see and hear at the same time. They either have to look at something or they have to listen. Simultaneous looking and listening may result in sensory overload and shutdown. This type of child may respond best when the teacher whispers quietly in a dimly illuminated room.
 
A good teacher needs to tailor his/her teaching method to the child. To be successful, the teacher has to be gently insistent. A good teacher knows how hard to push. To be successful, the teacher has to intrude into the autistic child's world. With some children the teacher can jerk open their "front door;" and with other children, the teacher has to sneak quietly in their "back door."
 
9. Why does my child want to wear the same clothes all the time?
Stiff scratching clothes or wool against my skin is sandpaper ripping off raw nerve endings. I am not able to tolerate scratching clothes. Autistic children will be most comfortable with soft cotton against their skin. New underwear and shirts will be more comfortable if they are washed several times. It is often best to avoid spray starch or fabric softeners that are placed in the dryer. Some children are allergic to them. [Note: Caretakers and teachers should also avoid the use of perfume because some children hate the smell and/or they are allergic to it.]
 
Even today at the age of 49, I have had to find good clothes and work clothes that feel the same. It takes me up to two weeks to habituate to the feeling of wearing a skirt. If I wear shorts during the summer, it takes at least a week before long pants become fully tolerable. The problem is switching back-and-forth. Switching back-and-forth can be made more tolerable by wearing tights with skirts. The tights make the skirt feel the same as long pants.
January, 1998
 
 
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Toilet Training Made Semi-Easy
by Kent Moreno
(Note: Kent Moreno is a Behavior Analyst and father of a child with Down syndrome. He is employed by the West Virginia Austism Training Center at Marshall University as an education specialist. He can be reached at 
knm@access.mountain.net.)
  
The process of teaching a child to use the toilet can be a frustrating one. This is especially true if the child has a developmental disability. The protocol listed below has been used successfully, with individuals with developmental disabilities of all ages.
 
In addition to the protocol listed below, It can be helpful if a child is able to observe others using the toilet. This may be something which a family is not comfortable with or is not appropriate in certain settings. That's fine.
 
A major factor in the success of this program is based on the development of an effective toileting schedule. To determine the right schedule for the child, data needs to be taken for at least 2-3 days on how often the child goes to the bathroom. To do this, dry pants checks should be done every 20 - 30 min (20 minutes is preferable). If your lucky, you can find diapers which have a strip which changes color when the child voids otherwise, it will be necessary to feel for moisture. Take special care to write down the times of the day that the child defecates as most people defecate at approximately the same time each day. This procedure is called baseline data. Once 2-3 days of data has been gathered, it will be necessary figure out approximately how often the child goes to the bathroom. To do this, divide the number of waking minutes by the number of times the child went to the bathroom.
 
The toileting schedule can now be set up. As a rule of thumb, the child should be taken to the bathroom, twice as often as the child's average for urinating and defecating. So, for example, if the child goes to the bathroom an average of once an hour, the child would be taken to the bathroom every 1/2 hour. When setting up the toileting schedule, keep in mind the times of the day that the child is most likely to defecate and try to have the toileting schedule occur close to these times.
 
Prior to taking the child to the bathroom, give the child a cue that it is time to go to the bathroom. I recommend helping the child to make the sign for toilet until they can make it independently. Using the sign for toilet will not stop those children who are verbal from saying "toilet" and will give the child a way of communicating when they have to go to the bathroom once they have mastered the toileting procedure thus making a toileting schedule unnecessary.
 
It is important that the bathroom be a very fun place. Reserve a couple of the child's favorite toys or books which they can only have access to while they are seated on the toilet. Also, music can be very helpful. Mozart and Rockabilly seem to work well.
 
When having the child sit on the toilet, don't force it. The experience needs to be a positive one. If the child doesn't want to sit on the toilet, leave the bathroom and try again at the next scheduled time.
 
Also, don't have the child sit on the toilet for more than 5-7 minutes. If the child is going to void in the toilet, they will usually do it within that time frame. If the child voids in the toilet, make a big deal out of it, praise the child verbally and tactilely (hugs, pats on the back...) and give them access to a small very preferred edible reinforcer (not always necessary). While it will be important to reduce the use of the edible reinforcers as quickly as possible but, in the early stages of acquiring toileting skills, it will be more important to make voiding in the toilet an extremely momentous and positive experience for the child.
 
One modification which can be made to the protocol which many times will increase the child's rate of success at voiding in the toilet is to give them something to drink 15-20 min prior to the scheduled toileting time.

Copyright 1996 by Kent Moreno, All rights reserved
 
 
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The Challenge Of Potty Training
By Maureen Bennie
  
Potty training is a normal part of childhood development but a difficult task at the best of times. Having a child with numerous developmental delays and sensitivities makes the task of teaching potty training even more challenging.
 
Even though there are no statistics on delayed toilet training in late talkers or developmentally delayed children there certainly seems to evidence that supports the theory that children with delays tend to be late potty trainers. There are several things we can do as parents to make the process an easier one and allow the child to have success.
 
Even before your child is interested or capable of starting potty training, introduce him/her to the potty-chair. Leave it sitting out in the bathroom so it becomes a familiar sight. Begin by having your child sit on the potty-chair fully clothed with a book to look at. Make set times in the day to have a seat on the potty, perhaps after a meal or before bedtime as part of the getting ready for bed routine.
 
Autistic children tend to be very visual so offering them visual supports is important. Using picture symbols going through each step of going to the potty is helpful. Our son has a booklet that hangs on the doorknob in the bathroom that breaks down every step beginning with pulling down his pants to ending with washing and drying his hands. We also read books about going to the potty. Some great ones are Alona Frankel's Once Upon A Potty available in a boys or girls edition, On Your Potty by Virginia Miller, and I Can Go Potty by Bonnie Worth featuring the Muppet Babies. A great video that handles all aspects of toilet training including not wanting to leave an activity the child enjoys is The Bear in the Big Blue House: Potty Time with Bear. It encourages the child to be independent, not to worry about leaving diapers behind, and it's OK to have accidents.
 
As parents, we have to be patient with our children and not rush the potty training process. Autistic children are also battling sensory defensiveness, which impedes this process. They don't know when they need to go, when their diaper is full, or how to release their bowels and bladder when on a potty-chair. Any new sensation or routine around that sensation can be frightening to them, as they don't always understand fully what is going on.
 
Peer support at New Heights, the preschool our son attends, has been motivating because he wants to follow what the other boys are doing. Perhaps an older sibling can mentor at home. Our own children seem to be most resistant to us as their parents in giving them direction. Using a chart at home can also be a motivator when your child has had success on the potty. The child can place a sticker of a character he likes such as Blues Clues or even numbers counting the number of successes he/she has had.
 
There is an agency in Calgary, Alberta called Aids to Daily Living, which subsidizes diaper costs for children three and over who are not toilet trained yet. The agency pays 75% of the cost and you pay 25% up to $500. If your yearly bill exceeds $500, the cost of diapers is free. They will not cover children who use diapers just for nighttime. Both diapers and pull-ups are funded. You can chose which store you would like to set up an account at. You fill out the paperwork at their office, which is located at 320 - 17th. Ave. SW (tel.) 228-7470. I found this agency to be friendly, supportive, and helpful. You may be able to find such an agency in your own town or city that will support the extended costs of having a child who is a late toilet trainer due to a disability.
 
A great deal of encouragement and praise goes a long with children so give a round of applause and a hug for any attempt made. Each child has their own personal clock and like all of their other skills that they develop, potty training will come in time too. 
 
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Potty Training Guidelines

1. Buy lots of the child’s favorite drinks and salty foods.
 
2. Make sure the “ultimate” reinforcer is available to the therapists/parents for the child’s successes on the potty.
 
3. Buy regular underwear
 
4. Buy a potty seat that fits on top of the regular toilet and a stool for the child to rest his feet.
 
5. Prepare activities for the child to do while seated on the potty such as; puzzles, books, manipulative toys.
 
Day 1
 
1. When the child wakes up, dress him/her in a shirt or sweatshirt, underwear and socks
 
2. Makes sure all SR+ items, activities, drinks, salty foods and the potty area is set up.
 
3. Begin giving the child liquids (LOTS!) for about 5 minutes.
 
4. Continue giving the child liquids until he/she is on the potty.
 
5. Start entertaining activities such as singing songs, puzzles, toys, etc.
 
6. Keep the child on the potty until he/she is successful. This can be a long time, 1-2 hours. This time will be this days baseline time.
 
7. Once the child is successful, reward the child greatly verbally and with his/her ultimate reinforcer item. Let the child off the potty for 10 minutes with his or her underwear off in the bathroom area. Continue fluids at this time.
 
8. Once the 10 minutes are up, put the child back on the potty until he or she is successful or the baseline time is up. Whichever is first.
 
9. If the child is successful, reward him or her greatly and let the child off the potty for 10 minutes in the bathroom area. If the child does not go, let him or her up for 3 minutes in the bathroom area and then bring the child back to the potty.
 
10. Continue these steps until the child has 3 successes on the potty.
 
11. After 3 successes, decrease the amount of fluids and gradually increase the amount of time off the potty by 3 - 5 minute increments. Remember to keep the child’s baseline time documented on the potty chart.
 
12. Continue with this for the rest of the waking hours of that day.
 
Day 2
 
1. Re-start the entire potty training procedure to get a new baseline time for the day. Each subsequent day you should see a decrease in the baseline times. At some point, the child should go as soon as you set him or her on the potty.
 
2. Continue with this for the rest of the waking hours of that day.
 
Day 3
 
1. Re-start the entire potty training sequence to establish the new baseline.
 
2. Use the amount of time from Day 2 off the potty time and let the child be able to go into 2 rooms of the house supervised.
 
Consequence for Accidents
 
Have the child clean up the accident with hand over hand prompts.
 
Have the child rinse out his/her clothing and get dressed. Put the child back on the potty. Add 10 minutes to the time the child sits before the baseline time begins. In essence, the child sits on the potty longer.
 
GOOD LUCK! Remember to be patient, potty training can take up to a week. Remember to document times on and off the potty with the Potty Chart.
 
Special thanks to Autism Spectrum Consultants for their Potty Training information and Potty Chart. For more information about Autism Spectrums Consultants go to: www.autismconsultants.com
 

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This information is posted here with the permission of the writer, Steven F. Trimarco.
 
Hi Everyone,

I have posted this article in my group and I thought I would share it with this group Because kids that have ADHD have a higher occurrence of incontinent issues then the general public!

Since summer is once upon on us, and the issue of traveling and summer camp for kids always comes up. So I would like to share my thoughts with the group in regard to these issues.

Once again I would like emphasize that incontinent products (Diapers, Pull-ups) are nothing more than another form of underwear, and because you wear these products it does not make you any less or any better than anyone else just like wearing glasses. No one thinks any less of anyone who needs to wear glasses nor should you think any less of yourself because you need to wear protection, again it is just another form of underwear.

Where you chose to spend the night

When traveling where you chose to spend the night whether it is at hotel or at a family or friends house. You must be considerate where you are going to stay, because of possibility of accidents from leakage from your protection.

With Hotels

With hotels you may be held liable for ruining a mattress that was not protected. If you inform them that your family has incontinent issues then they know and could provide antiquate protection for the mattress. Remember they deal with the traveling public all the time, and hearing about incontinent issues is a very common thing that they deal with.

Now if you chose not to inform the hotel, because you wish to be discreet and you feel you have adequate protection. Such as using a pull up vinyl covers over the diapers and disposable mattress pads. You could still experience a leak because moving around at night may dislodge the disposable mattress pads, and if this happens you may end up paying for a new mattress.

With Friends or Family

With Friend or Family you may choose to protect your child from possible embarrassment and being discreet about it, but accidents can still happen and they (family and your friends) may be very upset that you didn't inform them.

I had one report of parent that had fully prepared to provide adequate protection for their child and they think no one would be the wiser. But the child fell a sleep watching TV with his cousins and had an accident on the couch. So I believe if you were invited to stay with family or friend . You should out of consideration to them since they had invited you that you inform them about the incontinent issue and that you will bring adequate protection.

With summer camp

With summer camp it is necessary to inform them of your child incontinence and what protection will be needed to keep them protected.  Summer Camp for kids like hotels deal with all the time, and you could visit with them beforehand on how your child privacy and hygiene can be met.

Summer Camps will welcome your child. They want you child have a good time and want your child to come back. So indeed they are motivated to making your child a happy camper and make sure their needs are met.

Transportation

If you are traveling by car and have a child that is not Diurnal (Day time wetting), and is affected by Nocturnal Enuresis (Bedwetting) you may want them to wear protection.

(Please note if your are using disposable you should use a vinyl cover over the disposable, because disposable can leak and also urine can weep through the plastic covering the disposable)

Also you should put a disposable matters pad for them to sit on just in case the protection leaked , because your child only has Nocturnal Enuresis (Bedwetting) he or she may fall asleep they may have an accident and dealing with urine smell in the car seat for the rest of the trip will be no fun.

If you have been invited to travel in a friend or family car you should out of consideration to them since they did invite you that you inform of your family incontinence, and you could inform them that you have taken adequate precautions.

If you are traveling by Plane there are issues of going through the screeners and discovering your diapers. You may discreetly ask them do be discreet what they find in the bag. They have seen this before and this will not surprise to them, and they will be discreet. The alternative is for you to mail or purchase your diapers at your destination.

Supplies

Depending whether you are on a short trip or a long trip will determine whether you should take all the supplies with you or ship it to the hotel or Family\friend where you will be staying.

Take at least twice the supplies you need and extra change of clothes.
 
Traveling can be stressful and can lead to more accidents.

The following idioms for traveling:

1) Diapers (pull-ups);

2) Diapers wipes;

3) Powder;

4) Baby lotion;

5) Cream for diaper rash;

6) Disposable Mattress pads

Travel & Have a Good Time !!

Finally don't let being incontinent hamper you from traveling. My best memories growing up was traveling with my family and it was a wonderful experience. So again Don't let protection hamper your fun in anyway. Just wear what you need too when you have to and ENJOY YOURSELF !

Sincerely,

Steven F. Trimarco

http://health.groups.yahoo.com/group/staydry/


www.bedwettingchild.com <
http://www.bedwettingchild.com/> for incontinent products






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