Tuesday, 27 August 2013

We Are Moving!

Today we bid farewell to this faithful blog site as we move to our new web page!
Thanks for all the support you have given us here over the few years that we have had this blog site. Let's carry forward the support to the new blog page which is linked directly to our brand new website!
Click here to be directed to our new page!

All of us at EAP Malaysia wish you many thanks and look forward to more excitement!
EAP Malaysia

Thursday, 22 August 2013

Tolerance to Eating

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Many children with autism have difficulties eating a variety of food. Some of them may be on a specific diet plan, but the rest may not. We often come across children with autism who are not on any specific diet, choosing only to eat specific foods. Parents may have to prepare the same food everyday just so their children would fill their stomachs with something rather than nothing. This strategy of feeding them with the same food every single day may just work in a short period of time. However, it may unlikely last long. Tolerance to food can be implemented to desensitize the fear and to expose them to a variety of foods. There are so many ways to implement this strategy, depending on each child’s learning abilities. What follows is an example of one way to approach this.
You will need:
1) Social Story on Eating
2) Video Model on Eating
3) Eating utensils

Step 1: Social Story
A Social Story helps to prepare the child about what will take place when trying new food. It can also highlight what the expected behaviours are, the reinforcement or reward that the child can obtain, and also some of the coping strategies should the child feels anxious. Depending on the child’s learning ability, the social story can have more pictures than words or vice versa. As long as the child is comfortable reading it or it being read to them, then you are on your way to achieve your goal!
Here is an example of a social story on Eating:

Step 2: Video Model
Video models can be very helpful to the child too. It can include someone the child is familiar with to help them understand better that it is alright to try eat something new when they see the other person doing it. Feel free to include some scenes or shots with their peers or teachers doing it too. Positive and encouraging comments in the video to highlight the efforts made by those modelling can serve as reinforcements to the child. Alternately, tangible rewards can be presented too upon trying out new food.
Step 3: Practice
While we help the child to be successful in building their tolerance to anything, in this case to eating, it is imperative to remember to make the child feel successful at every step, even if it means they are all broken down to very small steps. After going through the social story and video model, the child can then practice eating new food.
Initial Stage: This stage can include the presentation of the targeted food (i.e. carrot, rice, etc.) in a small plate. This plate can be positioned near the child during snack time or lunch time. The tolerance can be built by slowly decreasing the gap between the plate and the child.
Experiment Stage: In this stage, the child should be able to tolerate having the food near the meal. It is time to try new food! Remember that each step can be broken down into much smaller steps to some children. For example, some children may need to tolerate tapping the small piece of food while others may straight away hold it by the hand. The tolerance can gradually be improved depending on the child’s needs. Should the child show any signs of anxiety, feel free to take a step back. Our goal is to allow the child tolerate trying new food successfully. So if the child is not ready to move to the next step, take a step back and slowly help them build their tolerance while continuously praising them for their effort. A tangible reinforcement may help too!
As the child moves on, we can slowly teach the child to tap the food on their lips and then slowly to bite a small piece and spitting it out if they are not ready to swallow.
Final Stage: This stage may just highlight the child’s ability to tolerate the presence of the new food in their mouth. Once they are able to swallow the food, the child can be presented with a super surprise to encourage the expected positive behaviour. Praise and label with comments like, “Wow! You ate carrots! You are a champion!” to highlight the expected behaviour performed.
These are just basic guidelines on one way to help the children to build their tolerance to eating. Different children may require different approaches to be successful in building this tolerance. Be creative and flexible to prepare the approach that may work best for each of them. If Plan A does not work, there is always Plan B and C and D up until the 26th alphabet. Don’t give up and keep trying! While we have to always remember to praise the child for their effort, we can praise ours too.
We hope these guidelines are helpful for any child to build their tolerance to eating. Remember that reinforcement is always crucial for the child to be motivated. Providing a variety of super excellent reinforcement can be very helpful. Have fun trying!
Written by:
Emma Sajidah
Supervisor Intern, EAP Malaysia.\

Tuesday, 20 August 2013

Tolerance to Crowd

Children on the spectrum may find it difficult to be in a crowded area. There are many factors that trigger this behaviour. One of the reasons could be lack of predictability; they are unsure with the surroundings, lack of communication or lack of tolerance to sounds.
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There are many ways that we can teach them to tolerate to crowds:
1. Social story about crowds
- I like to go out with mummy and daddy.
- When I go into the supermarket there are many people. It’s ok.
- I can hold mummy’s hand, I can help daddy to push the trolley.
- If it’s too loud I can tell mummy that it is loud and I can wear headphones or ear plugs.
- It is not a big deal.
2. Prepare a video
3. Visual Schedule

4. Practice and Role play. Start off with less crowded area and then gradually increase to crowded area. 
5. Calendar will be a great way to increase their predictability. 
6. Rewards - It is important to reinforce your child’s effort with strong reinforces.
Written by:
Supervisor, EAP Malaysia

Thursday, 15 August 2013

Tolerance to Showering

Showering for kids diagnosed with autism can be challenging for both child and parent. Children with autism may experience meltdowns in understanding the importance of hygiene. But again, it is imperative to teach them the importance of having a shower. Here are some tips that you could try out with your child:
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1. Prepare a social story on the importance of hygiene. The story could include that if they shower, they will be germ free and will smell better and that it is difficult to make friends if they smell bad.

2. Develop routines to help our kids. It is important to put up a shower visual on your kid’s daily routine schedule. It will give them some prediction as to when their shower time will be. Remember to do this daily with our child as bathing is a must just like going to bed and eating.

3. Routine in the shower. I have done this programme with a child before and it was very successful because the child knew what he was supposed to do in the shower. He had a schedule for a shower routine. Giving him/her a token for every step done can increase motivation. Below is an example of a shower routine:

4. Video Modelling. A video model allows our child to see what showering is like and how fun it can be. It will also help them to reduce any fear they have of showering.

5. Reinforcement. Reward them once they have completed the shower routine! We want showering to be a positive association for our child and the use of reward will help to promote that.

6. Using a timer. You could let your kids know how long they will be in the shower. This will help by giving them predictability. To make it more fun, you could play a song and let them know that once the song is all done, shower time is done too!!

7. Child’s sensory needs. There could be overwhelming stimulators when our kids are taking a bath. For example, the sound of the running water, the smell of the soap or shampoo. Do try out what works for the child initially. Always remember how we can make it fun and successful for the child.

8. Desensitizing child to bathing time. Parents could do some play time in the bathroom and make it a fun for the child and then slowly integrate them into the bath tub / shower area.

9. Lastly, have lots of FUN!!

 Hygiene is important for our kids and it’s also important to fix a routine for them. Repetition does play an important role, therefore following the daily schedule everyday will help increase predictability for the child and makes shower time more successful.
Written by:
Nisha Naomi
Intern Supervisor, EAP Malaysia

Tuesday, 13 August 2013

Hair Cutting Tolerance

For many children with autism, hair cutting can be a stressful experience. It is thus common to hear of creative ways around this, such as cutting a child’s hair while he is asleep. However, such practice will unlikely sustain in the long term. Like many other tolerance concerns that children on the spectrum might have, we can desensitize this fear through a Tolerance to Hair Cutting programme. Here we provide you a step by step guide on how to implement this.

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What you will need:
1. Social Story on Hair Cutting
2. Video Model on Hair Cutting
3. Hair Cutting Equipment: Scissors, Cape, Spray Bottle, Mirror (for Mock Practice)
Step 1: Preparing a Social Story
A Social Story is a narrative of an event that is going to take place. It is a common strategy employed with children with autism. Points to include when developing a Social Story are what would take place during hair cutting, the expected behaviours and the reward component. Visual illustrations should be used to support better understanding. Here is an example of a Social Story:
A Social Story should be prepared well in advance prior to the hair cut. Depending on the child, some may take a longer time for desensitization.
Step 2: Video Model
After reading the Social Story to the child, you could show your child a video model of someone having a haircut. This video model can be made by you with help from family members. Siblings often serve as good models for children with autism. In the video, remember to highlight praise for the child for trying.
Step 3: Practice
It is now time to practice. With the materials listed above, set up a mock hair cutting session. It is important that you keep the child successful. Hence, initial mock practices should be easy and short. This can then gradually increase as the child adapts to the situation. Here are some pointers.
- Snipping from afar for 5 seconds
- Snipping from afar for 10 seconds
- Snipping from afar for 20 seconds (gradually increasing up till 15 minutes)
- Snipping a cm of hair
- Snipping a longer strand of hair
Remember that these are just pointers. Adapt these to suit your child’s needs. For example, a child with an intense fear for hair cutting may require an initial step of tolerating the scissors. Other times, you may have to arrange a few visits to the barber shop, each increasing in time spent there.
The key is to create an enabling and successful environment for the child. Teach the child coping strategies such as watching a video while having a haircut. Or this could be reading a book or singing a song. 
It is of utmost importance to continually praise the effort that the child is showing.
Step 4: Big Day
The three steps above will prepare your child for the big day – the day he gets an actual hair cut. Predictability is key so utilise a calendar for countdown. However be flexible and assess the situation to suit the child’s needs.
Earlier we spoke about the reward component. Hence, in addition to the little rewards throughout for effort, the child must be rewarded on the big day. This reward has to be of value to your child. Hence it would vary from having ice cream to getting a new toy to a big cheer. Also remember that it is crucial to reward the effort regardless of outcome.
We hope that these guidelines are useful for you to support your child with having a haircut. Make this as fun a process as possible for the child. Finally, always praise the effort!

Written by:
Charmaine Koay
Supervisor Intern, EAP Malaysia

Thursday, 8 August 2013

Introducing Tolerance Programs!

For the months of August and September, EAP Malaysia's team of Supervisors will be posting articles to do with Tolerance. Many children on the Autism Spectrum have difficulties tolerating certain things. For example, a child may find it challenging to get their hair cut, to eat certain food or even to visit the dentist. For this matter we need to desensitize our kids to get them comfortable to tolerating these procedures.

As there are an endless amount of tolerance programs, we have put together a few of the common ones and hopefully with this you will be able to come up with your own tolerance program if ever needed. Here's what we will be targeting:

- Hair Cutting
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- Showering

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- Crowded Places

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- Food Tolerance

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- Cutting Nails

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- Visiting the Dentist

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For each of these tolerance programs, our team will teach you how to write the social stories, prepare video models, provide us with all the materials needed an will walk us through each step. Stay tuned!
EAP Malaysia

Tuesday, 6 August 2013

Autism Spectrum Disorder DSM-5

As we have previously posted up an article on the changes of the DSM-5, here's a video that explains the changes in greater detail: