Students with ASD: How to adjust to a new routine this school year

By Megan Swinford, social worker, Thompson Autism Center at CHOC Children’s

Speak to any parent, and you’ll gain insight into the roller-coaster ride they’ve been on the past several months during the COVID-19 pandemic. Parents have adapted to having their children at home full-time while balancing their own work schedule, virtual learning, and have essentially transformed themselves into teachers.

Parents of children with autism spectrum disorder (ASD) or special needs have had even more barriers to overcome, since Applied Behavior Analysis (ABA) therapy that children usually receive with a therapist in their home has declined due to the pandemic. Now that the school year is upon us, how can you prepare your child with ASD to return to school and adjust to the new normal?

Regardless of which structure your child’s school district offers, your child’s success in school will depend on their ability to adapt and be flexible to an ever-changing environment. This is no simple request considering students with ASD may have challenges with flexibility. The good news is there are ways that parents and teachers can work together to help ease their student’s anxiety:

  • Talk to the teacher about your child’s triggers for anxiety. If your child had virtual learning at home last spring, you’ve probably become more aware of their frustrations and triggers. Triggers may range from sensory issues to unstructured time to virtual interfacing with classmates or their teacher. Whatever their triggers are, it will be key for you to communicate these with your child’s teacher.
  • Create social stories with help from a behavioral analyst and/or teacher. Before in-person learning begins, reach out to your child’s therapy providers and have them practice social stories such as hand-washing, personal space and mask-wearing. This will help normalize some of the new procedures that your child will be faced with this year and prepare them for a better outcome. As a parent, getting involved in these therapy sessions, and understanding how you can translate and practice these social stories at home, will also be helpful.
  • Prepare a schedule—as best as you can. If your child will attend in-person learning this fall, get a copy of your child’s schedule and see if you’re able to visit the classroom before school is in session to build familiarity. Ask their teacher what health precautions will be enforced so that you can practice them. If your child’s school will continue with remote learning, follow these tips: try to have a start/end time each day, incorporate physical breaks that are planned for both you and your child, and create visual schedules.
  • Award flexibility with lots of praise and rewards. Make sure to award or praise even the smallest progress with your child’s flexibility toward new situations. This will encourage your child to respond positively to changes they may not be able to control. Since children with ASD can struggle without a consistent and dependable routine, teaching and reinforcing flexibility will be a strong skillset to develop.
  • Practice flexibility and openness yourself. Try to be open to unexpected outcomes, as hard as that can be. This will help model behavior for your child to follow. Flexibility and openness will be key in the next year, as schools adjust to putting new protocols in place to safeguard their students.
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What to expect at the Thompson Autism Center during COVID-19

Changes due to COVID-19 can be stressful for everyone, but especially for children with autism spectrum disorder (ASD) and their families. Here are some tips from a CHOC psychologist on helping your child with autism understand and cope with COVID-19.

Some families may be worried about going to a healthcare facility or doctor’s office during the COVID-19 pandemic. But now, more than ever, it is important for children with ASD to stay on schedule with clinical appointments, to prevent or address physical and mental health problems.

The Thompson Autism Center at CHOC Children’s is taking extra steps to help patients continue to get the care they need safely and with minimized stress.

Safety precautions

The Thompson Autism Center has implemented the following precautions to ensure the safety and well-being of patients, families and staff and decrease the risk of spreading illness:

  • A week before, as well as the day before your appointment, you will receive a phone call from a Thompson Autism Center staff member who will ask a series of screening questions related to COVID-19 exposure. These questions may include, “Have you or anyone in your family been exposed to someone with COVID-19 in the past two weeks? Have you or anyone in your family, been sick with cough, fever, runny nose, shortness of breath or upper respiratory symptoms?
  • Please bring masks for you and your child and wear them for the duration of your time in the center.
  • We ask that only one parent or guardian accompany each patient to their appointment. A home health nurse may also attend if necessary.
  • All visitors, patients and staff are screened at the center’s front door every day, via temperature checks and questions about recent exposure and health status.
  • Additional cleaning and other protocols have been enacted to ensure safety.

To help patients cope with the changes at the center, videos are available for your child to watch when you arrive, covering topics such as how to wear a mask, how your temperature will be checked and what to expect during your visit.

We recommend that you practice wearing a mask with your child before your visit. Here are some tips from a CHOC psychologist on how to help children who are afraid of wearing masks. If you have concerns about your child and masks, please speak to their physician.

Telehealth for autism appointments

In order to minimize the number of patients and families in the Thompson Autism Center at any one time, telehealth appointments are now available for certain types of visits, such as medication checks, initial assessment appointments and other appointments as necessary. To make these appointments most beneficial for you and your child, we offer these recommendations:

  • We recommend that you use a camera-equipped desktop or laptop computer, tablet or touchpad device rather than a smartphone. This allows our providers to have a full view of your child and observe how they behave in their environment, which is a key part of autism therapy.
  • Sit in a room that can be limited to just you and your child, free from noises, distractions and other people coming in and out.
  • During the telehealth visit, we will likely spend part of the appointment without your child present, just as we do during your in-person appointment. It will be important to have a caregiver or activity available to occupy your child, allowing you to concentrate on the visit and be able to freely speak without worry of upsetting your child if you need to talk about topics that may be irritating or bothersome to them.

We appreciate your patience as we navigate the fluid environment created by COVID-19. As we implement changes, we assure you that we remain dedicated to our mission to provide your child medical, psychological and behavioral treatment as well as support for your family.

This article was updated on June 23, 2020.

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How to help children with autism understand COVID-19

With schools and many businesses closed amid the COVID-19 pandemic, parents and kids are spending more time at home — and away from others — to help stop the spread of the virus. Adjusting to a new routine is stressful for parents and kids alike — but especially for children with autism who have trouble with change.

How can you help your child with autism understand what’s going on and what to expect from day-to-day? Pediatric psychologist Dr. Jina Jang offers tips for parents on helping their child adjust during this uncertain time.

What should I tell my child about coronavirus?

Kids with autism may not know what is going on, or they might not be able to express their fears and frustrations.

So it’s important to talk to your child about coronavirus in a way that’s simple to understand. Be clear, direct and honest. For example, “Coronavirus is a germ. It can make people very sick. We have to stay away from others right now to stay healthy.”

Go over important rules, and help your child to:

  • Wash hands well, for at least 20 seconds, and was them often. Here’s a pediatrician’s guide to proper hand-washing.
  • Try not to touch their nose, mouth, and eyes. Practice social distancing, keeping at least 6 feet away from other people. Wear a mask in public places.

Give your child space and time for questions, but don’t offer more detail than it takes to address their questions. For example, if your child asks about people who are sick, answer the question. But don’t bring up the topic if it doesn’t come up.

How can I help my child with autism understand COVID-19?

Kids with autism may need extra support to understand what’s going on around them, and what’s expected of them in some situations.

Social stories are stories that teach kids what happens in some situations and explain what kids should do in those situations. Several social stories about COVID-19 have been developed; reading the stories to or with kids may help them better understand COVID-19 and their feedings and offer assurance.

Visual supports may be helpful to break down the steps of the new “rules” around specific behaviors:

  • greeting people (e.g., no more handshakes, high fives)
  • washing hands often
  • social distancing
  • distance learning
  • new routines at home

You know how your child learns best, so use learning methods that have worked in the past.

How can I help my child adjust to changes brought on by COVID-19?

Routines are comforting for all kids, but especially for kids with autism, so do your best to keep as many of your normal routines as you can. Stick to regular bed and wake-up times, meal and snack times, screen time, chores and other household routines. But build in new routines to include schoolwork, breaks and exercise.

When possible, help your child take control by giving a couple of choices. For example, you could let your child choose what to eat for lunch. When doing schoolwork, you can ask what your child would like to do next.

Visual schedules and to-do lists can help kids know what to expect, while timers and 2-minute warnings can help with transitions.

Having a set routine and clear expectations will help lower the anxiety that can happen when things change.

Here’s more tips for establishing structure and routine while kids are home during COVID-19.

How can I help my child stay calm?

Kids with autism who feel frustrated, worried, or scared may have more repetitive behaviors (like hand flapping or rocking), tantrums, and other challenging behaviors.

Find ways for your child to express feelings. To help kids work through strong emotions, try:

  • talking together
  • doing crafts
  • writing
  • playing or acting out fears
  • for kids who are nonverbal, using augmented (or alternative) communication devices

Parents can also try calming activities, such as deep breathing, music, or watching a favorite video throughout the day. Exercise also can help ease anxious feelings.

While caring for your child, be sure that you take breaks and recharge too. Here’s a pediatrician’s advice for how parents can deal with stress during COVID-19.

Resources for parents with autism

Your child’s healthcare provider, teacher, or behavior or learning specialist can offer more tips to help your child during this time.

Talk to your provider if you notice changes in your child’s sleeping or eating habits, or if your child seems more worried or upset than usual. These may be signs of anxiety or depression.

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Can children outgrow autism?

A study recently published in the Journal of Child Neurology suggests that children may outgrow autism. We spoke to Dr. J. Thomas Megerian, pediatric neurologist and clinical director of the Thompson Autism Center at CHOC Children’s, about what parents should know about these findings.

What does this study’s findings mean for parents?

Many parents ask me, “Will my child outgrow autism?” and I always tell them that what we hope for is that with services and growth, the child will improve so much that after as little as a few years, they no longer meet the criteria for Autism Spectrum Disorder (ASD). Outgrowing the label may mean they have learned to compensate or overcome some challenges like socialization or repetitive movements. They may have little features left of ASD, and what symptoms they do have, may cease to interfere with their development or daily lives. When they have progressed to the point where they have outgrown the label, any remaining traits may be so small that only a parent would notice, but a new person who has just met the child wouldn’t pick up on anything.

However, I advise my patients’ parents that if and when their child outgrows the label of autism, they may still have other co-occurring issues like anxiety, attention deficit hyperactivity disorder (ADHD) or learning disabilities that require ongoing care.

So yes, indeed this study should give parents hope surrounding a child’s ability to outgrow the autism label, despite their other potential ongoing issues.

In some instances, schools may suggest a decrease in services because a child has improved and outgrown the label of autism. That same child may still be struggling with organization or learning certain subjects. Parents may be in a position to say that just because their child has outgrown the autism label doesn’t mean they do not have a need for additional support.

What does life look like for a child previously diagnosed with autism who is no longer on the spectrum?

Learning disabilities, obsessive compulsive disorder, and attention deficit disorder are common among children with ASD. Rates of other disorders are common among children with autism, including: gastrointestinal disorders, ear infections, seizures and anxiety. They may clear up later in life or become better managed, but they don’t necessarily go away at the same time as their autism label.

Residual symptoms of these co-occurring diagnoses may last into adulthood. For example, a child may outgrow their ASD label but still have anxiety that can be managed by cognitive behavioral therapy.

Why is early detection and early intervention of autism so important?

Early detection and intervention help many kids outgrow the autism label in the future due to improvements with socialization and repetitive behavior. It’s important for people to remember that just because they have lost the autism label, doesn’t mean they don’t have other diagnoses or disorders that may require ongoing treatment.

There’s no question that early intervention makes a big difference in helping kids with the potential to outgrow their ASD diagnoses achieve that milestone even sooner. The trajectory has changed for many of those kids.

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CHOC Children’s and Thompson Foundation Announce New Autism Center

CHOC Children’s and the William and Nancy Thompson Family Foundation (Thompson Family Foundation) recently unveiled a new collaboration that expands our region’s capacity to serve children with autism spectrum disorders (ASD) and their families. The Thompson Autism Center at CHOC Children’s, named in honor of a $10 million founding gift, will be devoted to evaluating children as early as possible to promote better outcomes; engaging children whose behaviors diminish quality of life for them and their families; and establishing a long-term support system for children with complex care needs.

Bill-and-Nancy-thompson-autism-center-choc-childrens
Bill and Nancy Thompson

The Thompson Autism Center will also, through a partnership with Chapman University, assist families in navigating the education system from preschool to college. In support of the Thompson Family Foundation’s vision to bring hope to children with ASD and their families, the Thompson Autism Center will participate in national research networks.

“A national leader, the Thompson Family Foundation has earned a stellar reputation for expanding services, research, education and advocacy for children with ASD and their families. We are grateful for their generous support and their commitment to enrich so many lives here in Orange County,” said CHOC Children’s President and CEO Kimberly Chavalas Cripe.

The Thompson Autism Center will focus on three high-need populations

  1. Early intervention has been shown to significantly improve the development of basic cognitive, relational and communications skills; however, most children are not diagnosed with ASD until their fourth birthdays. The Thompson Autism Center will assess, treat, develop care plans and provide follow-up services for undiagnosed children, ages 1 – 6.

 

  1. Some children with ASD communicate with negative behaviors such as aggression and self-injury, resulting in physical, emotional and social impacts on them, their parents and siblings. The Thompson Autism Center will partner with families to provide a multi-tiered intervention program.

 

  1. Epilepsy, sleep disorders, gastrointestinal issues and other medical problems commonly occur in children with ASD. The Thompson Autism Center will provide comprehensive, interdisciplinary care and family support services to address ASD and its common co-occurring conditions.

“We take pride in collaborating with institutions and health care professionals who share our vision to dramatically improve the lives of children with autism and other neurodevelopmental disorders and their families, “said Bill Thompson, co-founder, Thompson Foundation. “Our collaboration with CHOC Children’s will complement and expand on the work already being done in Orange County, making a lasting impact on the community and bringing hope to children and families affected by ASD”

The Thompson Autism Center is set to open in early 2019 and will be located at 170 S. Main Street in Orange, only a few blocks from CHOC’s main hospital campus. The two-story, approximately 20,000-square-foot facility will be designed by FKP/CannonDesign, an architectural and design firm with national experience in neuroscience, brain and autism projects at children’s hospitals.

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